# 171 - 463 ( Rev 12 / 1 7 ) IN THE CIRCUIT COURT OF THE NINETEENTH JUDICIAL CIRCUIT LAKE COUNTY, ILLINOIS ) ) ) Plaintiff(s) ) vs. ) ) ) ) Gen No . Defendant(s) ) MOTION FOR REFERRAL TO MORTGAGE FORE CLOSURE MEDIATION Defendant in support of this motion, states as follows: (print name) 1. No Judgment of Foreclosure has been entered in this case. 2. No Summary Judgment Motion is pending or has been granted in this case. 3. I have not previo usly participated in the Foreclosure Mediation Program. 4. This case is app ropriate for mediation because: Therefore, I respectfully request this Court to grant my motion for an order referring this case to the Foreclosure Mediation Program. // Signature Date Prepared by: Name: Pro Se Address: City: State: Phone: Zip Code: ARDC #: E - mail address: American LegalNet, Inc. www.FormsWorkFlow.com