Free CCM 0051 8-18-04 - Illinois

Complaint - Distress for Warrant (This form replaces CCM1 0051) IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS

(Rev. 8/18/04) CCM 0051 A

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Plaintiff(s) v.

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Defendant(s)

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No. ____________________________________ Amount claimed $ _________________________ Return date ______________________________

COMPLAINT
Copy of Distress Warrant To ____________________________________________________________________________________________ You are hereby authorized to distrain the personal property of ______________________________________ wherever the same may be found in the County of Cook, for the sum of $ _____________________________, being the amount due on _______________________________________, _________, for rent of the following described premises in the County of Cook leased to the Defendant by me: ____________________________________________, and for so doing this shall be your sufficient warrant. Given under my hand on _________________________________________________________, _________.

_____________________________________________
Landlord

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Attorney(s) for Plaintiff(s) I, ____________________________________________, on oath state that I am the ______________ Plaintiff in the above entitled action. The allegations in this Complaint are true. There is due thereon from the Defendant(s) to the Plaintiff(s) after allowing the Defendant(s) all just credits, deductions and set-offs, the sum of $ _____________________________________________ with interest thereon at

_________________ per cent per annum from _________________________________, _________, for rent of the
premises described in the foregoing distress warrant.

____________________________________, _________ _____________________________________________
Date Atty. No. _______________ Name: ________________________________________ Attorney for: __________________________________ Address: _______________________________________ City/State/Zip: __________________________________ Telephone: _____________________________________ DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS
(OVER)

Signature
[ ] Under penalties provided in 735 ILCS 5/1-109 the undersigned certified that the statements set forth herein are true and correct.

(Rev. 8/18/04) CCM 0051 B

NOTE

When the claim does not bear interest the part of the affidavit as to interest should be stricken out. INVENTORY OF PROPERTY LEVIED UPON

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