Supplement to Identity Theft Petition (3/28/05) CCCR 0018 IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS PEOPLE OF THE STATE OF ILLINOIS or ________________________________________________________, A Municipal Corporation, v. _______________________________________________, Defendant, ________________________________________________________, Petitioner. } Case No. ____________________________________ SUPPLEMENT TO IDENTITY THEFT PETITION _______________________________________________________ Charge(s) Against Defendant in Above Case: ________________________________________________________________ Case Number Falsely Containing Petitioner’s Identity: Date of Arrest: ________ /________ /________ Arresting Agency/Agencies: ______________________________________________ ___________________________ Petitioner’s IR/SID #, if any: __________________________ ________ /________ /________ Sex: ________ Race: ____________________________ Defendant’s IR/SID #, if any: Petitioner’s Date of Birth: _______________________________________________________ Charge(s) Against Defendant in Above Case: ________________________________________________________________ Case Number Falsely Containing Petitioner’s Identity: Date of Arrest: ________ /________ /________ Arresting Agency/Agencies: ______________________________________________ ___________________________ Petitioner’s IR/SID #, if any: __________________________ ________ /________ /________ Sex: ________ Race: ____________________________ Defendant’s IR/SID #, if any: Petitioner’s Date of Birth: _______________________________________________________ Charge(s) Against Defendant in Above Case: ________________________________________________________________ Case Number Falsely Containing Petitioner’s Identity: Date of Arrest: ________ /________ /________ Arresting Agency/Agencies: ______________________________________________ ___________________________ Petitioner’s IR/SID #, if any: __________________________ ________ /________ /________ Sex: ________ Race: ____________________________ Defendant’s IR/SID #, if any: Petitioner’s Date of Birth: _______________________________________________________ Charge(s) Against Defendant in Above Case: ________________________________________________________________ Case Number Falsely Containing Petitioner’s Identity: Date of Arrest: ________ /________ /________ Arresting Agency/Agencies: ______________________________________________ ___________________________ Petitioner’s IR/SID #, if any: __________________________ ________ /________ /________ Sex: ________ Race: ____________________________ Defendant’s IR/SID #, if any: Petitioner’s Date of Birth: (Attach additional sheets if necessary.) VERIFICATION BY CERTIFICATION Date: _________________________________, _________ Atty. No.: _________________ Pro Se 99500 Attorney (or Pro Se Petitioner): Name: ____________________________________________ Address: ___________________________________________ City/State/Zip: ___________________________________________ Telephone: ________________________________________ Under penalties as provided by law pursuant to Section 1-109 of the Code of Civil Procedure, 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. __________________________________________ Signature of Petitioner 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