Illinois > Local County > McHenry > Criminal
Mandatory Insurance Affidavit CR-AFF1 - Illinois
| Mandatory Insurance Affidavit Form. This is a Illinois form and can be used in Criminal McHenry Local County . |
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STATE OF ILLINOIS IN THE CIRCUIT COURT OF THE 22nd JUDICIAL CIRCUIT McHENRY COUNTY PEOPLE OF THE STATE OF ILLINOIS vs. ________________________________________ Defendant Case Number_________________________________ MANDATORY INSURANCE AFFIDAVIT I,______________________________________________________ being first duly sworn upon oath deposes and states as follows: 1. That I am a defendant in the above pending matter before the Twenty-Second Judicial Circuit for a violation of Failure to Carry an Insurance Identification Card as required by 7-601 of the Mandatory Insurance Code; 2. That I was presented a citation for violation of the Illinois Mandatory Insurance Act on ____________________________________, and at the time I was presented with the citation, I was covered by insurance as required by the Illinois Mandatory Insurance Act; 3. That the Certificate of Insurance issued by my insurance company__________________________ under policy number ______________________________________________________________ which began on ________________________ and expires on ____________________________; 4. I FURTHER UNDERSTAND THAT IF I FURNISH FALSE INFORMATION ON THIS AFFIDAVIT THAT I MAY BE ARRESTED FOR THE OFFENSE OF PERJURY WHICH IS A FELONY UNDER ILLINOIS LAW. ___________________________________________________ Defendant's Signature ___________________________________________________ Address ___________________________________________________ City, State Zip SWORN AND SUBSCRIBED before me _______________________________________, 20________ __________________________________________________ Notary Public / Circuit Clerk CR-AFF1: Revised 12/01/06 American LegalNet, Inc. www.FormsWorkflow.com
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