Free CCG 0642 1-5-01 - Illinois

2877 Cert. of Representation Filed

(Rev. 1/5/01) CCG 0642

IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS _______________ DEPARTMENT

No. _____________________________

REPRESENTATION BY CIVIL LEGAL SERVICES PROVIDER

I, _______________________________________, a civil legal services provider as defined by statute have
(attorney's name)

determined that __________________________________ is eligible to have all fees relating to filing, appearing,
(name of client)

transcript on appeal, and service of process waived because _________________________________'s income is
(name of client)

125% or less of the current official federal poverty income guidelines, or __________________________________ is otherwise eligible to receive civil legal services under the Legal Services Corporation Act of 1974.

_____________________________________________ Attorney Certification Civil Legal Services Provider: __________________________________ Attorney Name ______________________________________________ Attorney No. ________________________________________________ Address ____________________________________________________ City, State, Zip_______________________________________________ Telephone __________________________________________________

DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS