RESTRICTED FORM Notice of Confidential Information Within Court Filing (07/26/16) CCG N502 A IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS _________________________ DEPARTMENT, __________ DISTRICT ___________________________________________________________ Plaintiff/Petitioner v. No. ________________________________ ___________________________________________________________ Defendant/Respondent NOTICE OF CONFIDENTIAL INFORMATION WITHIN COURT FILING Pursuant to Illinois Supreme Court Rule 138(c), the filer of a document containing personal identity information required by law, ordered by the court, or otherwise necessary to effect disposition of a matter shall, at the time of such filing, include this confidential information form which identifies the personal identity information redacted from such filing pursuant to Rule 138(c), and which will be redacted from future filings to protect the subject personal identity information. This personal identity information will not be available to the public and this document will be stored in a separate location from the case file. For the entire case. (Check this box if you will be using the same redaction throughout the pendency of the case to refer to the same information.) For the filing titled __________________________________________ dated ______________________________ . (Check this box if this reaction only relates to a specific document filed in the case.) This information pertains to: This information pertains to: __________________________________________ (full name of adult) OR __________________________________________ (full name of adult) OR This information pertains to a minor with the This information pertains to a minor with the initials of ______ and the full name of initials of ______ and the full name of __________________________________________ . __________________________________________ . (full name of minor) (full name of minor) Address: _______________________________________ Telephone: _____________________________________ Date of Birth: __________________________________ Social Security No.: _____________________________ Taxpayer Identification No.: _______________________ Driver's License No.: ____________________________ Financial Account No.: __________________________ Debit or Credit Card No.: _________________________ Other information ordered by the court: ______________ ______________________________________________ Address: _______________________________________ Telephone: _____________________________________ Date of Birth: __________________________________ Social Security No.: _____________________________ Taxpayer Identification No.: _______________________ Driver's License No.: ____________________________ Financial Account No.: __________________________ Debit or Credit Card No.: _________________________ Other information ordered by the court: ______________ ______________________________________________ DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS Page 1 of 2 Notice of Confidential Information Within Court Filing This information pertains to: RESTRICTED FORM (07/26/16) CCG N502 B This information pertains to: __________________________________________ (full name of adult) OR __________________________________________ (full name of adult) OR This information pertains to a minor with the This information pertains to a minor with the initials of ______ and the full name of initials of ______ and the full name of __________________________________________ . __________________________________________ . (full name of minor) (full name of minor) Address: _______________________________________ Telephone: _____________________________________ Date of Birth: __________________________________ Social Security No.: _____________________________ Taxpayer Identification No.: _______________________ Driver's License No.: ____________________________ Financial Account No.: __________________________ Debit or Credit Card No.: _________________________ Other information ordered by the court: ______________ ______________________________________________ This information pertains to: Address: _______________________________________ Telephone: _____________________________________ Date of Birth: __________________________________ Social Security No.: _____________________________ Taxpayer Identification No.: _______________________ Driver's License No.: ____________________________ Financial Account No.: __________________________ Debit or Credit Card No.: _________________________ Other information ordered by the court: ______________ ______________________________________________ This information pertains to: __________________________________________ (full name of adult) OR __________________________________________ (full name of adult) OR This information pertains to a minor with the This information pertains to a minor with the initials of ______ and the full name of initials of ______ and the full name of __________________________________________ . __________________________________________ . (full name of minor) (full name of minor) Address: _______________________________________ Telephone: _____________________________________ Date of Birth: __________________________________ Social Security No.: _____________________________ Taxpayer Identification No.: _______________________ Driver's License No.: ____________________________ Financial Account No.: __________________________ Debit or Credit Card No.: _________________________ Other information ordered by the court: ______________ ______________________________________________ Additional pages attached. Atty. No.: ________________ Pro se 99500 Name: _________________________________________ Address: _______________________________________ City/State/Zip: ___________________________________ Telephone: ______________________________________ Primary Email: __________________________________ Secondary Email: ________________________________ Tertiary Email: __________________________________ Address: _______________________________________ Telephone: _____________________________________ Date of Birth: __________________________________ Social Security No.: _____________________________ Taxpayer Identification No.: _______________________ Driver's License No.: ____________________________ Financial Account No.: __________________________ Debit or Credit Card No.: _________________________ Other information ordered by the court: ___