Complaint - Distress for Warrant (This form replaces CCM1 0051) IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS (Rev. 8/18/04) CCM 0051 A ______________________________________________ Plaintiff(s) v. No. ____________________________________ Amount claimed $ _________________________ Return date ______________________________ ______________________________________________ Defendant(s) COMPLAINT Copy of Distress Warrant To ____________________________________________________________________________________________ You are hereby authorized to distrain the personal property of ______________________________________ wherever the same may be found in the County of Cook, for the sum of $ _____________________________, being the amount due on _______________________________________, _________, for rent of the following described premises in the County of Cook leased to the Defendant by me: ____________________________________________, and for so doing this shall be your sufficient warrant. Given under my hand on _________________________________________________________, _________. _____________________________________________ Landlord _____________________________________________ Attorney(s) for Plaintiff(s) I, ____________________________________________, on oath state that I am the ______________ Plaintiff in the above entitled action. The allegations in this Complaint are true. There is due thereon from the Defendant(s) to the Plaintiff(s) after allowing the Defendant(s) all just credits, deductions and set-offs, the sum of $ _____________________________________________ with interest thereon at _________________ per cent per annum from _________________________________, _________, for rent of the premises described in the foregoing distress warrant. ____________________________________, _________ _____________________________________________ Date Atty. No. _______________ Name: ________________________________________ Attorney for: __________________________________ Address: _______________________________________ City/State/Zip: __________________________________ Telephone: _____________________________________ DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS (OVER) Signature [ ] Under penalties provided in 735 ILCS 5/1-109 the undersigned certified that the statements set forth herein are true and correct. (Rev. 8/18/04) CCM 0051 B NOTE When the claim does not bear interest the part of the affidavit as to interest should be stricken out. INVENTORY OF PROPERTY LEVIED UPON ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS Print This Form For your protection and privacy, please press the Clear This Form button after you have printed the form. Clear This Form