22nd JUDICIAL CIRCUIT - McHENRY COUNTY APPLICATION FOR REMOTE ACCESS SERVICE I would like to apply to the 22nd Judicial Circuit, McHenry County, for remote access to the Court’s electronic databases. I understand and agree to pay the established fees for the use of this convenient method for access to official court records. I understand that this fully completed application will be approved or denied within 15 days of receipt. Date of Request: ________________________________________________________________ Name of Requester: ______________________________________________________________ Address of Requester: ____________________________________________________________ ________________________________________________________________________________ Phone Number: _____________________________E-mail Address:_______________________ Name of Company/Agency or Firm: _________________________________________________ List of names of personnel utilizing system: __________________________________________ ________________________________________________________________________________ Describe Information Requested (Be Specific): ________________________________________ ________________________________________________________________________________ Reason Information Desired: _______________________________________________________ ________________________________________________________________________________ Specify how information will be utilized: _____________________________________________ ________________________________________________________________________________ List Persons or Organizations to whom information will be disclosed or distributed: ________ ________________________________________________________________________________ I certify that all of the information contained in this application for Remote Electronic Access service is true and correct. Dated: ________________________ ______________________________________________ Signature of Requester ______________________________________________ Print Name McHenry County Remote Access Application - Page 1 of 1 Revised 12/01/06:kk American LegalNet, Inc. www.FormsWorkflow.com