STATE OF ILLINOIS IN THE CIRCUIT COURT OF THE 17TH JUDICIAL CIRCUIT WINNEBAGO COUNTY FILE STAMP CC- 233 V5 _______________________________ Plaintiff Vs _______________________________ Defendant CASE NO. __________________ JURY DEMAND The Plaintiff / Defendant _____________________________________________________________________________ in the above entitled case demands a jury for the trial of said cause. Attorney Name ___________________________________________________________ ARDC No. _______________________ Firm Name _____________________________________________________________________________________________________ Address ________________________________________________________________________________________________________ City/State/Zip _________________________________________________________________________________________________ Phone No. _______________________________________ Facsimile Telephone No. _______________________________ Email Address _________________________________________________________________________________________________ Pro Se Name (representing myself) _______________________________________________________________________ Address ________________________________________________________________________________________________________ City/State/Zip _________________________________________________________________________________________________ Phone No. _______________________________________ Facsimile Telephone No. _______________________________ Email Address _________________________________________________________________________________________________ Dated: ______________________________ Signature: ________________________________________ YOU MUST SEND COPIES OF THIS AND ANY OTHER DOCUMENT FILED TO OPPOSING PARTY/ATTORNEY OF RECORD American LegalNet, Inc. www.FormsWorkFlow.com