This form is approved by the Supreme Court of Illinois and is required to be accepted. EW - C 3401. 2 Page 1 of 2 (01/1) Instruction s THIS APPEAL INVOLVES A MATTER SUBJECT TO EXPEDITED DISPOSITION UNDER Check the box to the right if your case involves custody, visitation, or removal of a child. RULE 311(a). Case No.: Enter the Supreme Court case number if one has been assigned. IN THE SUPREME COURT OF ILLINOIS If the case name in the trial court and/or appellate court began with 223In re224 (for example, 223In re Marriage of Jones224), enter that name. Below that, enter the names of the parties in the trial/appellate court, and check the correct boxes to show which party filed the appeal in the Supreme Court (223appellant224) and which party is responding to the appeal (223appellee224). Appeal from the Appellate In r e Court, District No. Appeal from the Circuit Court Plaintiff/Petitioner (First, middle, last name s ) of County Appellant Appellee Trial Court Case No.: v. Honorable To the far right, enter the number of the appellate district, appellate court case number, trial court county, trial court case number, and trial judge's name. Defendant/Respondent (First, middle, last name s ) Appellant Appellee J udge, Presiding Provide this Certification in person or by mail to the Supreme Court Clerk 200 East Capitol Avenue, Springfield, Illinois 62701, along with the document you want to file. NOTE: If the document you want to file is one of the following: a brief, petition for rehearing, petition for leave to appeal, or any answer to a petition for leave to appeal or petition for rehearing, you must submit 13 legible copies to the Clerk's office, along with this Certification . CERTIFICATION FOR EXEMPTION FROM E - FILING 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. American LegalNet, Inc. www.FormsWorkFlow.com Enter the Case Number given by the Circuit Clerk: EW - C 3401.2 Page 2 of 2 (01/1) 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