Request for Preparation of Supplemental Record on Appeal (Rev. 9/02/08) CCA 0023 APPEAL TO THE APPELLATE COURT OF ILLINOIS FROM THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS ______________________ DEPARTMENT, ______________________ DIVISION/DISTRICT ________________________________________________ Plaintiff/Appell _____ v. ________________________________________________ Defendant/Appell _____ } Reviewing Court No. Circuit Court No. Honorable _________________________ ____________________________ __________________________________ Trial Judge Date of Order being Appealed ___________________ Date Notice of Appeal Filed _____________________ REQUEST FOR PREPARATION OF SUPPLEMENTAL RECORD ON APPEAL Attorney (or Party if no attorney): Name: __________________________________________ Cook County Attorney Code No. ____________ or Pro Se 99500 Address: ________________________________________ City: ____________________ State: ______ Zip: __________ Telephone Number: ________________________________ E-mail Address (optional) _____________________________ Attorney for: _______________________________________________________________________________________ Name of Party The Appellant in the above case has requested preparation of a Supplemental Record on Appeal for submission to the reviewing court pursuant to Illinois Supreme Court Rule 329. The Supplemental Record on Appeal should be prepared pursuant to the following: ‰ A stipulation signed by the parties (original attached). ‰ An order of court dated _____________________________ (copy with judge’s signature attached). If documents were filed under seal with the Circuit Court, this Order should authorize them to be unsealed for inclusion in the Record on Appeal, or in the alternative, an Order must be obtained from the Appellate Court authorizing the inclusion of sealed documents in the Record on Appeal. See Rule 17 of the Appellate Court of Illinois. ‰ Other (Please specify): _________________________________________________________________________ FEES Payment may be made by Cash, Check or Money Order. Cash payments accepted for in-person payments only. Checks or Money Orders should be payable to the Clerk of the Circuit Court of Cook County. Pursuant to 705 ILCS 105/27.2a(k) and 27.2(k), the Clerk of The Clerk of Circuit Court of Cook County must charge fees for the Record on Appeal in advance as follows: 100 pages or less, $110 100-200 pages, $185 Each page in excess of 200, $.30/page Reduced fee for Local Governments and School Districts, $50 All prescribed fees are due in advance of transmission of the Supplemental Record on Appeal. It is understood and agreed that, once a request for preparation of a Supplemental Record on Appeal is made by submission of this form, the Appellant is responsible for the costs of preparing the Supplemental Record on Appeal, regardless of whether the Appeal is successful, dismissed, the time is extended, or a party elects to not transmit the Supplemental Record on Appeal to the Appellate Court. The Clerk of Circuit Court of Cook County reserves the right to pursue a claim to recover the costs and expenses, including reasonable attorneys’ fees, related to the preparation of the Supplemental Record on Appeal. __________________________________________________ (Type or Print Name) ______________________________________ Signature of Requestor DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS