(This form replaces CCG-40B, 0040, 0601, 0605, 0629, 0630, 0631, 0632, 0633; CCMC-1.363-6055, 6056, CCMC-613, and CCCR-0084, 0093A & B, and CCCR-0606) Print Form Clear Form (Rev. 4/08/11) CCCR 0699 IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS People of the State of Illinois OR City/Village/Municipality of Case No. ______________________________ _____________________________________________ Plaintiff v I. R. # __________________________________ _____________________________________________ Defendant S. I. D. # _______________________________ CERTIFIED STATEMENT OF DISPOSITION/CONVICTION I, DOROTHY BROWN, Clerk of the Circuit Court of Cook County, Illinois, and keeper of the records and the seal thereof, do hereby certify the records of the Circuit Court of Cook County reflect: (*STRIKE ALL INAPPLICABLE STATEMENTS) *1. On __________________________________, _______, the State's Attorney of Cook County/local prosecutor filed an (information ‰/ complaint ‰) number______________________ charging the defendant with the offense(s) of _________________________________________________________________________________. *2. On _________________________________, _______, the duly impaneled Cook County Grand Jury for the month of ________________,_______, returned an indictment number _____________________ charging the above named defendant with the offense(s) of _________________________________________________. *3. On __________________________________, _______, the above-named defendant, while represented by counsel and fully advised of his/her rights, was arraigned before the Honorable_____________________ ______________________________________, Judge of the Circuit Court of Cook County, and entered a plea of (not guilty ‰/ guilty ‰). *4. A trial by jury (was ‰ was not ‰) waived by the defendant, who was represented by counsel; and defendant was found (not guilty ‰/ guilty ‰). *5. The defendant, after having been fully advised of his/her rights, and while represented by counsel, withdrew his/her plea of not guilty and entered a plea of guilty to______________________________________ (offense) on _______________________________, __________. *6. On ___________________________________, _______, a hearing was held in the above-captioned case before the Honorable _________________________________________, Judge of the Circuit Court of Cook County; the Order entered by the Court was: ____________________________________________________ _______________________________________________________________________________________ I hereby certify that the foregoing has been entered of record in the above-captioned case. COURT SEAL DATED: __________________________________, _______ __________________________________________________ Dorothy Brown, Clerk of the Circuit Court DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS