Print Form ‰517 TRIMS Code ‰474 KRIM Code Arrest Warrant Execution Verification Clear Form (1/18/11) CCG 0657 IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS ‰ PEOPLE OF THE STATE OF ILLINOIS or Case No.____________________________ ‰ ______________________________________________, A Municipal Corporation v. _________________________________________________ Defendant/Petitioner ARREST WARRANT EXECUTION VERIFICATION Pursuant to an arrest Warrant issued in the Circuit Court of Cook County, Illinois, for failure to appear for an alleged violation of the Criminal Code of 1961, the Illinois Vehicle Code, the Wildlife Code, the Fish and Aquatic Life Code, the Child Passenger Protection Act, or a comparable offense of a unit of local government as specified in Supreme Court Rule 551, the following arresting agency hereby certifies that it brought the offender in on the arrest warrant on _______________________________, __________: Apprehending Agency: _______________________________________ NCIC No(s). ___________________ Apprehending Officer(s): _______________________________________ Star No(s). ___________________ Address: _________________________________________________________________________________ City/State/Zip: ____________________________________________________________________________ I understand that, should an arrest warrant execution fee be ordered by the court pursuant to 725 ILCS 5/110-7(i), the Clerk of the Circuit Court of Cook County shall distribute the apprehending agency’s portion of that fee to the above-listed apprehending agency at the above-listed address. _________________________________________ Signature