Petition And Order To Sue Or Defend As An Indigent Person Form - Lake County, Illinois
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1IN THE CIRCUIT COURT OF THE NINETEENTH JUDICIAL CIRCUIT
LAKE COUNTY, ILLINOIS
________________________________________________ )
Petitioner,
)
vs.
)
Case No.
________________________________________________ )
Respondent.
)
PETITION AND ORDER TO SUE OR DEFEND AS AN INDIGENT PERSON
_________________________________________, filing a Petition to Sue or Defend as an Indigent Person, pursuant to
Supreme Court Rule 298 and Section 5/5-105 of the Code of Civil Procedure on oath states:
1. I am an indigent person under one or more of the following criteria:
a. I am a recipient of assistance under any of the following benefit programs:
Aid to the Aged, Blind and Disabled (AABD)
Food Stamps
General Assistance
State Children and Family Assistance
State Transitional Assistance
Supplemental Security Income (SSI)
Temporary Assistance for Needy Families (TANF)
b.
My available income is 125% or less of the current poverty level as established by the United States Department of
Health and Human Services.
c.
I am eligible to receive civil legal services as defined by 735 ILCS 5/5-105.5 of the Code of Civil Procedure.
d.
I am unable to proceed in an action without payment of fees, costs, and charges and my payment of those fees, costs,
and charges would result in substantial hardship to myself or my family.
2. I provide the support for ___________ child(ren) and/or dependents who live in my household.
3. The nature and value of property owned by me is:
Real: ________________________________________
Personal: _________________________________________
4.
a.
My employment status is as follows: (Check as applies)
unemployed
employed, and my current income is
$______________ per _____________.
b.
(If married) The employment status of my spouse with whom I
do
do not live with is as follows:
unemployed
employed and his/her current income is $______________ per._________________.
5.
I am
receiving
paying child support in the following amount: $______________ per._________________.
6.
My monthly living expenses are as follows: List your monthly living expenses. (Do not include payments for debts or child
support payments.)
_____________________________________________________________________________
________________
(Attach additional pages as needed)
Total $
7.
I believe, in good faith, I have a meritorious claim or defense.
WHEREFORE, petitioner prays this Court to grant leave to sue or defend as an indigent person.
VERIFICATION BY CERTIFICATION
Under penalties as provided by law pursuant to Section 1-109 of the Code of Civil Procedure, the undersigned certifies that the
statements set forth in this instrument are true and correct.
________________________________________
Petitioner
IF YOUR PETITION IS GRANTED, THE COURT MAY ORDER YOU TO PAY ALL OR A PORTION OF THE FEES, COSTS OR
CHARGES WAIVED OUT OF MONIES RECOVERED BY YOU PURSUANT TO ANY SETTLEMENT OR JUDGMENT
RESULTING IN THIS CASE.
O R D E R
Permission is hereby
granted
denied petitioner to sue or defend without payment of fees, costs, or charges.
The Sheriff of Lake County
is
is not ordered to serve process upon defendant without fee.
The County of Lake
is
is not ordered to pay costs of service by publication.
Other: _________________________________________________________________________________________________
If Petition is denied, reason(s) for denial: _____________________________________________________________________
______________________________________________________________________________________________________
Dated this ________ day of _______________, 20____
Enter: ___________________________________________
JUDGE
171 – 189 (Rev 06/13)
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