Illinois > Local County > Cook > Domestic Relations
Supportive Services Referral Order CCDR 0037 - Illinois
| Supportive Services Referral Order Form. This is a Illinois form and can be used in Domestic Relations Cook Local County . |
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4572 4406 - Case set on Progress Call Print Form Clear Form 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 (7/10/07) CCDR 0037 A ________________________________________________ PETITIONER AND ________________________________________________ RESPONDENT } NO: _______________________________ CALENDAR: _______________________ PREJUDGMENT POST JUDGMENT SUPPORTIVE SERVICES REFERRAL ORDER IT IS HEREBY ORDERED that the matter is referred as follows: A. DEPARTMENT OF SUPPORTIVE SERVICES (DSS); Cook County Administrative Building, 69 W. Washington, Suite 1630, 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 Interstate Compact (out of state) _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ 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 (7/10/07) 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 Department of Supportive Services 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
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