74091 PRO-SE BRANCH COMPLAINT & SUMMONS (This form replaces CCMD-138-3, CCM1 600 and CCMD 111-6) (Rev. 3/14/01) CCM 0138 IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS MUNICIPAL DEPARTMENT, ___________ DISTRICT ___________________________________________________ Plaintiff v. ____________________________________________________ Defendant } Case No. ____________________________________ Amount Claimed $ ____________________________ Return Date _________________________________ Trial Date ___________________________________ Court Room ______________ Time _____________ PRO SE COMPLAINT The Plaintiff states that he/she has a claim against the Defendant in the amount of $ ______________________ and court costs. The claim arose on or about _____________________________, ________ as a result of the following events: _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ The Plaintiff has demanded payment of said sum and the Defendant has refused to pay the same and no part thereof has been paid. Defendant resides at _______________________________________________________ Phone _______________________ Plaintiff resides at _________________________________________________________ Phone ______________________ The Plaintiff on oath states that the allegations of this complaint are true and that he/she has not filed more than three (3) complaints in this court within the last year. The undersigned above certifies that the statements set forth above are true and correct. _______________________________________________________ Plaintiff [ Under penalties as provided by law pursuant 735 ILCS 5/1-109. ] SUMMONS TO THE ABOVE NAMED DEFENDANT - YOU ARE SUMMONED AND REQUIRED: 1. To file, or have your attorney file, a written appearance in Room ___________, _____________________________ _________________________, Illinois, by _____________ M., on _____________________________, ________ 2. The case will be referred to a mediator for settlement. If the case is not settled, the matter will be set for trial at ____________ M. the same day. 3. To bring any witnesses, documents, photographs, repair bills and estimates you have to support your claim or defense. 4. An answer is not required unless ordered by the Court. 5. IF YOU FAIL TO APPEAR, A JUDGMENT WILL BE ENTERED AGAINST YOU FOR THE AMOUNT ASKED IN THE COMPLAINT PLUS COSTS. Witness __________________________, ________ ________________________________________ Clerk of Court 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