Free CCDR 0009 6-11-09.pmd - Illinois

Atty. No.:__________________ Name: ________________________________________________ Atty. for: ____________________________________________ Address: ____________________________________________ City/State/Zip: ________________________________________ Telephone: __________________________________________

7288, 7289 - Order Referred to FOCUS 4578 - Order Referred to MFCS 4572 - Order Referred to DSS 4616 - Order Referred to FCSD 4574 - Order Referred for Report to Court

(Rev. 6/11/09) CCDR 0009 A

IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS COUNTY DEPARTMENT, DOMESTIC RELATIONS DIVISION IN RE THE: MARRIAGE VISITATION CUSTODY PARENTAGE OF NO: ______________________________ CALENDAR: _______________________ PREJUDGMENT POST JUDGMENT
RESPONDENT

_____________________________________________
PETITIONER
AND

_____________________________________________

CIRCUIT COURT RULE 13.4(f) CONSOLIDATED REFERRAL ORDER: CONTESTED CUSTODY/VISITATION EDUCATIONAL PROGRAM, ILLINOIS MARRIAGE AND DISSOLUTION OF MARRIAGE ACT
THIS MATTER having been represented as involving custody and/or visitation of the child(ren) of the parties, IT IS HEREBY ORDERED that the matter is referred as follows: A. TYPE OF REFERRAL AND AGENCY

FOCUS ON CHILDREN parent education program (FOCUS); Cook County Administration Building, Suite 1000, 69 W. Washington, 10th Floor, Chicago, IL 60602; Telephone: (312) 603-1550 FAX: (312) 603-1588 or Suburban Municipal District ________ located at ____________________________________________________ For Petitioner Respondent Focus Class in Spanish
7288 7289

Focus on Children fee assessed for attendance, to be collected by the Clerk of the Circuit Court of Cook County is: $25.00 $ Set at ____________ Waived To be paid by Petitioner Respondent

4578

Marriage and Family Counseling Service (MFCS); Cook County Administration Bldg., Suite 1000, 69 W. Washington, Chicago, IL 60602; Telephone: (312) 603-1540 FAX: (312) 603-9842 or Suburban Municipal District ________ located at _________________________________________________ For Mediation Conciliation Reconciliation Emergency Intervention Nature of Emergency: _______________________________________________________________
ISSUE(S):_______________________________________________________________________

________________________________________________________________________
Please check if applicable: FOCUS ON CHILDREN IS A PRECONDITION TO MEDIATION. The parties and their attorneys are ordered to contact MFCS immediately when Emergency Intervention has been ordered. Office of Adoption and Child Custody Advocacy; Cook County Administration Bldg., Suite 818, 69 W. Washington, Chicago, IL 60602; Telephone: (312) 603-0550 (contact Social Services Coordinator) For General Study Specific Study Other
ISSUE(S):_______________________________________________________________________

4572

_______________________________________________________________________

(Rev. 6/11/09) CCDR 0009 B

Forensic Clinical Services Department (FCSD); 2650 S. California Ave., 10th Floor, Chicago, IL 60608;
4616

Telephone: (773) 869-6100 FAX: (773) 869-2371 (contact Administrator-Domestic Relations Program)
ISSUE(S):_______________________________________________________________________

_______________________________________________________________________
Private resources for
4574

Mediation

Evaluation

Other

Name: ________________________________________________________________________________________ Address: _______________________________________________________________________________________ Telephone and Contact: _________________________________________________________________________ Costs shall be paid by: ___________________________________________________________________________
ISSUE(S):_______________________________________________________________________

_______________________________________________________________________
B. SPECIAL CONSIDERATIONS

Pending DCFS Investigation C.

Order of Protection

Shelter Care

Other Pending Proceedings

Identification of Parties, Children, Attorneys
Child(ren)'s Full Name(s) Age Date of Birth Residential Address

____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________
Father: Name: _________________________________________ *Address: _______________________________________ Father 's Attorney: Name: _______________________________________ Address: _____________________________________

______________________________________________ Date of Birth: ___________________________________ Tel. No:(H) _____________________________________ (W) ___________________________________________

___________________________________________ Tel. No: ______________________________________ Fax:_______________________________________

Mother: Name: _________________________________________ *Address: _______________________________________

Mother's Attorney: Name: _______________________________________ Address: _____________________________________

______________________________________________ Date of Birth: ___________________________________ Tel. No:(H) _____________________________________ (W) ___________________________________________

___________________________________________ Tel. No: ______________________________________ Fax:_______________________________________

(Rev. 6/11/09) CCDR 0009 C

Other: Name: _________________________________________ *Address: _______________________________________

Attorney: Name: _______________________________________ Address: _____________________________________

______________________________________________ Date of Birth: ___________________________________ Tel. No:(H) _____________________________________ (W) ___________________________________________
Child's Representative/Guardian Ad Litem/Attorney for Child
Name: _________________________________________ Address: _______________________________________ Telephone: _____________________________________ Fax: __________________________________________

___________________________________________ Tel. No: ______________________________________ Fax:_______________________________________

D.

Unless otherwise provided by court order, all Forensic Clinical Services Department (FCSD) evaluations, Office of Adoption and Child custody Advocacy, reports and reports or evaluations for Private Resources shall be in writing and sent to the Court and all attorneys of record 10 days prior to the date set forth in paragraph E below. This matter is set for status on __________________________________ at _____________ m. in Room ___________ at the courtroom located at __________________________________. The parties and their attorneys shall appear.

E.

F.

For all referrals, except emergency intervention, the attorney for ___________________________________ shall contact the referred agency within 10 days of the entry of this order and transmit all appropriate pleadings with this order within 10 days of the entry of this order. All parties shall promptly and fully comply with the requirements of any referred agency.

Atty. Code No. _______________ Name: ____________________________________________ Attorney for: ______________________________________ Address: __________________________________________ ENTERED: City/State/Zip: _____________________________________ Telephone: ________________________________________ Fax: _____________________________________________ Dated: ________________________, __________

________________________________________
Judge Judge's No.

*If a party has not disclosed an address, that party shall designate an alternative address for the purpose of notice.