Illinois > Secretary Of State > Court Of Claims
Application To Sue Or Defend As A Poor Person - Illinois
| Application To Sue Or Defend As A Poor Person Form. This is a Illinois form and can be used in Court Of Claims Secretary Of State . |
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Illinois Court of Claims Office of the Secretary of State 630 S. College St., Springfield, IL 62756 Application to Sue or Defend as a Poor Person IN THE COURT OF CLAIMS, STATE OF ILLINOIS ) ) ) ORDER vs. ) No. _____ Application Granted ) _____ Application Denied ) _____________ , 20 _____ ) _______________________ ) JudgeI, ________________________________________________________________________ ______________________________________ ? on my own behalf ? as _______________________________________________________, on behalf of ___________________________________, Parent, Guardian, Other Name a ________________________________________________called applicant on oath state: Minor, Incompetent 1. Applicants occupation or means of support: a. Applicant is employed as ______________________________________by ______________________________________ . Job Employer 2. Applicants income for the preceding year: $ ________________________________________________________________. 3. Sources and amount of income expected by applicant hereafter: _______________________________________________ ________________________________________________________________________ ____________________________________ 4. Persons dependent on applicant for support: __________________________________________________________________ ________________________________________________________________________ ____________________________________ 5. Applicant owns (a) no real estate except: (State Address or Location, Nature of Improvements and V________________________alue) ________________________________________________________________________ ____________________________________ ________________________________________________________________________ ____________________________________ and (b) personal property, which in the aggregate does not exceed $ _________________in value and consists of: ________________________________________________________________________ ___________________________________ , including a __________________________motor vehicle, ________________________valued at $ ___________________ . Make Year 6. No applications were filed by or on behalf of applicant for leave to sue or defend as a poor person during the preceding year except: ________________________________________________________________________ ______________ ________________________________________________________________________ ____________________________________ 7. Applicant is unable to pay the costs of this case. 8. Applicant has a meritorious ________________________________________________________________________ _________ Claim Defense Printed by authority of the State of Illinois - March 2005 - 500 - CC-90 American LegalNet, Inc. www.USCourtForms.com<<<<<<<<<********>>>>>>>>>>>>> 2NOTE: If incarcerated at the time of this application, a certified copy of the inmate s trust fund must be attached tothis application. ________________________________________________ Signature Signed and sworn to before me ____________________________________ , 20 ________ ________________________________________________ Notary Public ________________________________________________ Name ________________________________________________ Attorney for Application ________________________________________________ Street Address ________________________________________________ City ________________________________________________ Telephone This state agency is requesting disclosure of information that is necess ary to accomplish the statutory purpose as outlined under 705 ILCS 505/1 et seq. Disclosure of thisinformation is REQUIRED. Failure to provide any information will result in this form not being processed. Printed by authority of the State of Illinois - March 2005 - 500 - CC90 American LegalNet, Inc. www.USCourtForms.com
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