Pro Se Complaint for Illinois Administrative Review (Rev. 7/16/01) CCM 0005 IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS ______________ MUNICIPAL DISTRICT - CIVIL DIVISION __________________________________________________ Plaintiff v. CITY OF CHICAGO Department of Administrative Hearings, and CITY OF CHICAGO, Department of No. ______________________________ (Will be assigned by Court Clerk) RE: ______________________________ __________________________________________________ Defendant(s) PRO SE COMPLAINT FOR ILLINOIS ADMINISTRATIVE REVIEW 1. Plaintiff, _______________________________________ pursuant to 735 ILCS 5/3-101 et al., complaints of the Village/City of ________________ Department of Administrative Hearings and the City of ________________, Department of ____________________________________, as follows: a. Plaintiff resides at _____________________________________________________________________; b. A final administrative decision was rendered on _________________________________, _________ by the Village/City of ______________, Department of Hearings, affecting the rights of the Plaintiff; c. Plaintiff desires review of case Docket Number _____________________________, because this decision is not in accordance with the law. A copy of the decision is attached; Final Determination d. The Plaintiff has exhausted all available administrative remedies under the Act and has no further plain, speedy, adequate remedy in the ordinary course of law. WHEREFORE, the Plaintiff prays that said record be judicially reviewed. (Please Print) Name: ________________________________________ _________________________________________ Address: _____________________________________ Plaintiff Pro Se City/State/Zip: __________________________________ Telephone: ____________________________________ ÉR EAD • • • • THE FOLLOWING VERY CAREFULLY: This appeal procedure is available only to review a Hearing Officer's Determination, not a Default. This Complaint must be filed within 35 days after the date of the Hearing Officer's Determination. A copy of the Hearing Officer's Determination must be attached to this Complaint. Failure to comply with these instructions will result in the dismissal of this Complaint. 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