(Rev. 3/19/01) CCM 0699 A IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS NOTICE OF TERMINATION OF TENANCY To: _______________________________________________________________________ ____________________________________________________________________________ __________________________________________________________________________ You are hereby notified that your tenancy of the following premises to wit: __________________________________________________________________________ ____________________________________________________________________________ __________________________________________________________________________ ____________________________________________________________________________ in the County of Cook and State of Illinois, will terminate on the _____________ day of _________________________________, _________. You are hereby required to surrender possession of the said premises to the undersigned on that day. This notice of termination is issued based on the following: _________________________ __________________________________________________________________________ ____________________________________________________________________________ __________________________________________________________________________ ____________________________________________________________________________ __________________________________________________________________________ Date: ___________________________________, _________ _____________________________________ Lessor ______________________________________ Agent or Attorney PERSON SERVING NOTICE MUST COMPLETE AFFIDAVIT AND PROOF OF SERVICE ON REVERSE SIDE. DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS (Rev. 3/19/01) CCM 0699 B State of Illinois County of Cook } ss: AFFIDAVIT AND PROOF OF SERVICE _________________________________________, certifies and says that he/she served the foregoing NOTICE OF TERMINATION OF TENANCY on this ________ day of ___________________, _______ as follows: q By personally delivering a true and correct copy to Tenant. q By leaving a true and correct copy with ____________________________________________ a person of the age of 13 years or upwards, residing on or in the premises. q By mailing a true and correct copy to the Tenant by Certified or Registered Mail, requesting a return receipt signed by Addressee only (Certified or Registered Mail Receipt No. _________________________________) and depositing same in the U. S. Mail located at _____________________________________ ________________________________________________________________________ Under penalties as provided by law pursuant to Section 1-109 of the Illinois Code of Civil Procedure, the undersigned certifies that the statements set forth in this Affidavit and Proof of Service are true and correct in substance and in fact. _____________________________________________ Print This Form For your protection and privacy, please press the Clear This Form button after you have printed the form. Clear This Form