ORDER - BOND REFUND STATE OF ILLINOIS 1065 Rev. (9/13) UNITED STATES OF AMERICA COUNTY OF DU PAGE IN THE CIRCUIT COURT OF THE EIGHTEENTH JUDICIAL CIRCUIT PEOPLE OF THE STATE OF ILLINOIS vs CASE NUMBER DEFENDANT File Stamp Here ORDER FOR BOND REFUND I HEREBY REQUEST that the Court enter an order for refund payment, whatever amount of bail deposit remaining after the ordered deductions, to my attorney or other person as indicated below. (725 ILCS 5/110-7). Surety * signed in open court Defendant * signed in open court * If not signed in open court, signature must be notarized or supported by affidavit. IT IS HEREBY ORDERED, that any attorney requesting a bond refund, must file a W-9 form with the Clerk of the Court before any monies are dispersed. IT IS FURTHER ORDERED, that the bail heretofore posted in this cause by surety / defendant, be refunded less all fines, costs, statutory fees, and other purposes as authorized by the Court (725 ILCS 5/110-7). The check is to be made payable to: (print only) The mailing address of the check is: (print only) Name: DuPage Attorney Number: Attorney for: Address: City/State/Zip: Telephone Number: PRO SE Date Judge CHRIS KACHIROUBAS, CLERK OF THE 18th JUDICIAL CIRCUIT COURT © WHEATON, ILLINOIS 60187-0707 American LegalNet, Inc. www.FormsWorkFlow.com