Free CCDR 0037 6-11-09.pmd - Illinois

4572

4406 - Case set on Progress Call (Rev. 6/11/09) CCDR 0037 A

Supportive Services Referral Order

IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS COUNTY DEPARTMENT, DOMESTIC RELATIONS DIVISION IN RE THE MARRIAGE VISITATION CUSTODY PARENTAGE OF

________________________________________________
PETITIONER AND

________________________________________________
RESPONDENT

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NO: _______________________________ CALENDAR: _______________________

PREJUDGMENT POST JUDGMENT

OFFICE OF ADOPTION AND CHILD CUSTODY REFERRAL ORDER
IT IS HEREBY ORDERED that the matter is referred as follows: A. Office of Adoption and Child Custody Advocacy; Cook County Administrative Building, 69 W. Washington, Suite 818, Chicago, IL 60602; Telephone (312) 603-0550 Fax: (312) 603-9909 For Petitioner Respondent

B. For the following: Home visit in Cook County out of Cook County

_______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________
School Records (please provide name and address of school) ________________________________________

_______________________________________________________________________________________ _______________________________________________________________________________________ _________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________
Emergency Monitoring (not to exceed one visit per month during a six (6) month period)

__________________________ _______________________________________________________________________________________ _______________________________________________________________________________________

(OVER) DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS

(Rev. 6/11/09) CCDR 0037 B

C. Identification of Children, Parties, Attorneys and Child Representatives: Child(ren)'s Full Name(s) D.O.B. Party with whom Child(ren) Resides

___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________
Petitioner: Petitioner's Attorney: Name: _______________________________________ Atty. No. _______________ Address: _____________________________________ Name: _____________________________________________ ____________________________________________ Address: _______________________________________ Date of Birth: _________________________________ ______________________________________________ Telephone (H): ________________________________ Telephone: ______________________________________ (W): ________________________________________ FAX: _______________________________________ Respondent:
Name: _______________________________________ Address: _____________________________________

Respondent's Attorney:
Atty. No. _______________ Name: _______________________________________ Address: _______________________________________

____________________________________________ Date of Birth: _________________________________ Telephone (H): ________________________________ (W): ________________________________________

______________________________________________ Telephone: ______________________________________ FAX: ___________________________________________

Child(ren)'s Representative/Guardian ad Litem/Attorney for Child: Atty. No. _______________ Name: _______________________________________ Address: _____________________________________

____________________________________________ Telephone: ___________________________________ FAX: ________________________________________
D. This matter is set for status on ______________________________ at _________ m. in Room _________
(Status date should not be set prior to 67 days from the date of this Order.)

**The Court must fax this Order to the Office of Adoption and Child Custody Advocacy at (312) 603-9909. Atty. No.:__________________ Name: ____________________________________ ENTERED: Atty. for: ____________________________________ Address: ____________________________________ Dated: ______________________________, ___________ City/State/Zip: ________________________________ Telephone: __________________________________ _____________________________________________ Judge Judge's No. FAX: ____________________________________ DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS