This form is approved by the Illinois Supreme Court and is required to be accepted in all Illinois Circuit Courts. EW - C 3401. 2 Page 1 of 1 (01/1) STATE OF ILLINOIS , CERTIFICATION FOR EXEMPTION FROM E-FILING For Court Use Only CIRCUIT COURT COUNTY Instructions Directly above, enter the name of the county where the case was filed. Enter the name of the person who started the lawsuit as Plaintiff/Petitioner. Plaintiff / Petitioner ( First, middle, last name ) Enter the name of the person being sued as Defendant/Respondent v. Enter the Case Number given by the Circuit Clerk or leave this blank if you do not have one. Defendant / Respondent ( First, middle, last name ) Case Number In 1, check the reasons you are asking to file by mail or in person. You should check all that apply. 1. I am not able to e - file documents in this case for the following reasons (c heck all that apply) : I am representing myself and do not have the Internet or a computer in my home . M y only access is through a public terminal at a courthouse, library, or other location. You are exempt from e-filing and you do not need to file this Certification if: you are in jail orprison; you are filing awill; you are filing intoa juvenile case; OR your disabilityprevents you from e - filing. This poses a financial or other hardship. I am representing myself and have trouble reading, writing, or speaking in English. I am filing a document in a sensitive case, such as a petition for an order of protection or a civil no contact/stalking order. 2. Illinois Supreme Court Rule 9(c)(5) allows for an exemption from e - filing for good cause. For the above reasons, I need a good cause exemption from e - filing for my entire case or until I am able to e - file. Under the Code of Civil Procedure, 735 ILCS 5/1-109 , making a statement on this form that you know to be false is perjury, a Class 3 Felony. I certif y that everything in the Certification for Exemption from E - filing is true and correct. I understand that making a false statement on this form is perjury and has penalties provided by law under 735 ILCS 5/1 - 109 . After you finish this form, sign and print your name. Your Signature Street Address Enter your complete address and telephone number. Print Your Name City, State, ZIP Telephone American LegalNet, Inc. www.FormsWorkFlow.com