Petition for Certificate of Relief from Disabilities or to Enlarge the Relief Previously Granted in a Certificate of Relief from Disabilities (01/08/16) CCCR N510 A IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS PEOPLE OF THE STATE OF ILLINOIS or ______________________________________________, A Municipal Corporation No._________________________________ v. _________________________________________________, Defendant/Petitioner PETITION FOR A CERTIFICATE OF RELIEF FROM DISABILITIES OR TO ENLARGE THE RELIEF PREVIOUSLY GRANTED IN A CERTIFICATE OF RELIEF FROM DISABILITIES Pursuant to 730 ILCS 5/5-5.5-5 et seq. the Petitioner petitions the Court to order that: Petitioner has qualified for a Certificate of Relief From Disabilities or he relief previously granted in a Certificate of Relief From Disabilities shall be enlarged, and in support of the t Petition states as follows: 1. Petitioner was not convicted of an offense or attempted offense that would subject a person to registration under the Sex Offender Registration Act, 730 ILCS 150/1 et seq., the Arsonist Registration Act, 730 ILCS 148/1 et seq., or the Child Murderer and Violent Offender Against Youth Registration Act, 730 ILCS 154/1 et seq. 2. Petitioner was not convicted of committing aggravated driving under the influence of alcohol, other drugs or drugs or intoxicating compound or compounds or any combination thereof; or aggravated domestic battery. 3. Petitioner was not convicted of an offense or an attempted offense of arson; aggravated arson; kidnapping; or aggravated kidnapping. 4. (Check if applicable) The Petioner has previously been granted a Certificate of Relief from Disabilities on __________________________ and seeks enlargement of the Certificate in order to obtain relief to apply for additional licenses or certification, as indicated in paragraph 6 (Attach a copy of the court order granting the Certificate.) 5. Petitioner seeks a license or certification pursuant to the following (Check all that apply): The Animal Welfare Act [Petioner was not convicted under Section 3, 3.01, 3.02, 3.03, 3.03-1 or 4.01 of the Humane Care for Animals Act, 510 ILCS 70/3, 510 ILCS 70/3.01, 510 ILCS 70/3.02, 510 ILCS 70/3.03, 510 ILCS 70/3.03-01 or 510 ILCS 70/4.01 or Section 26-5 of the Criminal Code of 1961, 710 ILCS 5/26/-5 or Section 48-1 of the Criminal Code of 2012, 720 ILCS 5/48-1] e Illinois Athletic Trainers Practice Act, 225 ILCS 5/1 et seq. Th The Barber Cosmetology, Esthetics, Hair Braiding and Nail Technology Act of 1985, 225 ILCS 410/1-1 et seq. The Boiler and Pressure Vessel Repairer Regulation Act 225 ILCS 203/1 et seq. The Boxing and Full-Contact Martial Arts Act, 225 ILCS 105/1 et seq. The Illinois Certified Shorthand Reporters Act of 1984, 225 ILCS 415/1 et seq. The Illinois Farm Labor Contractor Certification Act, 225 ILCS 505/1 et seq. The Interior Design Title Act, 225 ILCS 310/1 et seq. The Illinois Professional Land Surveyor Act of 1989, 225 ILCS 330/1 et seq. The Illinois Landscape Architecture Act of 1989, 225 ILCS 315/1 et seq. The Marriage and Family Therapy Licensing Act, 225 ILCS 55/1 et seq. The Private Employment Agency Act, 225 ILCS 515/0.01 et seq. The Professional Counselor and Clinical Professional Counselor Licensing Act, 225 ILCS 107/1 et seq. DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com Petition for Certificate of Relief from Disabilities or to Enlarge the Relief Previously Granted in a Certificate of Relief from Disabilities (01/08/16) CCCR N510 B 6. The Real Estate License Act of 2000, 225 ILCS 454/1-1 et seq. The Illinois Roofing Industry Licensing Act, 225 ILCS 335/1 et seq. Professional Engineering Practice Act, 225 ILCS 325/1 et seq. Water Well and Pump Installation Contractors License Act, 225 ILCS 345/1 et seq. Electrologist Licensing Act, 225 ILCS 412/1 et seq. The Auction License Act, 225 ILCS 407/5-1 et seq. Illinois Architecture Practice Act of 1989, 225 ILCS 305/1 et seq. The Dietetic and Nutrition Services Practice Act, 225 ILCS 30/1 et seq. The Environmental Health Practitioner Licensing Act, 225 ILCS 37/1 et seq. The Funeral Directors and Embalmers Licensing Code, 225 ILCS 41/1-1 et seq. The Land Sales Registration Act of 1999, 765 ILCS 86/1-1 et seq. The Professional Geologist Licensing Act, 225 ILCS 745/1 et seq. The Illinois Public Accounting Act of 1989, 225 ILCS 340/1 et seq. The Structured Engineering Practice Act of 1989, 225 ILCS 340/1 et seq. The Petitioner states the relief should be granted for the following reasons: ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ 7. The relief to be granted by the Certificate is consistent with the public interest. 8. Petitioner understands that, for the purpose of determining whether the certificate shall be issued, the court may elect to request that the probation or court services department conduct an investigation of the Petitioner, and that they submit to the court a written confidential report in accordance with the request. 730 ILCS 5/5-5.515(c). WHEREFORE, the Petitioner petitions this court to: A. order that the Petitioner has qualified for a Certificate of Relief from Disabilities, or B. order that the Petitioner has qualified for enlargement of the relief offered by the Certificate of Relief froM Disabilities previously issued to Petitioner. _________________________________________ Signature of Defendant/Petitioner VERIFICATION BY CERTIFICATION Under penalties as provided by law pursuant to Section 1-109 of the Code of Civil Procedure, 735 ILCS 5/1-109, the undersigned certifies that the statements set forth in this instrument are true and correct, except as to matters therein stated to be on information and belief, and as to such matters the undersigned certifies as aforesaid that s/he verily believes the same to be true. _________________________________________ _________________________________________ Date Signature of Defendant/Petitioner Atty. No. _____________________ Pro se 99500 Atty. Name: ______________________________ Atty. for: _________________________________ Address: _________________________________ City/State/Zip: ____________________________ Telephone: _______________________________ Primary Email: ______________