Certification of Judgment Balance Employer Name Address: Address: Re: _____________________________________________ ___________________________________________ ______________________________________ Defendant: _____________________________________ Case No. _______________________________________ Balance Due at End of Last Calendar Quarter: _________ Creditor: Pursuant to the Illinois Code of Civil Procedure, Section 12/808.5, the undersigned hereby certifies that the above amount is the balance due on the judgment as of the last day of the last calendar quarter. Please note that the law requires the employer to hand deliver or mail by First Class Mail a copy of this certification to the judgment debtor at the judgment debtor's last known address. ______________________________________ Attorney for Judgment Creditor or Pro Se Creditor (Rev. 4/01/01) CCM 0199 Print This Form For your protection and privacy, please press the Clear This Form button after you have printed the form. Clear This Form