Supplement to Identity Theft Petition (1/19/16) CCCR N018 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 Case Number Falsely Containing Petitioner's Identity: _______________________________________________ Charge(s) Against Defendant in Above Case: _______________________________________________________ Date of Arrest: ____________________ Arresting Agency/Agencies: ___________________________________ Defendant's IR/SID # if any: ______________________ , Petitioner's IR/SID #, if any: _____________________ Petitioner's Date of Birth: ___________________________Sex: _________ Race: _________________________ Case Number Falsely Containing Petitioner's Identity: _______________________________________________ Charge(s) Against Defendant in Above Case: _______________________________________________________ Date of Arrest: ____________________ Arresting Agency/Agencies: ___________________________________ Defendant's IR/SID #, if any: ____________________ Petitioner's IR/SID #, if any: ________________________ Petitioner's Date of Birth: ___________________________Sex: _________ Race: _________________________ Case Number Falsely Containing Petitioner's Identity: _______________________________________________ Charge(s) Against Defendant in Above Case: ______________________________________________________ Date of Arrest: ____________________ Arresting Agency/Agencies: ___________________________________ Defendant's IR/SID # if any: ______________________ , Petitioner's IR/SID #, if any: _____________________ Petitioner's Date of Birth: ___________________________Sex: _________ Race: _________________________ Case Number Falsely Containing Petitioner's Identity: ________________________________________________ Charge(s) Against Defendant in Above Case: _______________________________________________________ Date of Arrest: ____________________ Arresting Agency/Agencies: ___________________________________ Defendant's IR/SID # if any: ______________________ , Petitioner's IR/SID #, if any: _____________________ Petitioner's Date of Birth: ___________________________Sex: _________ Race: _________________________ (Attach additional sheets if necessary.) VERIFICATION BY CERTIFICATION Date: ______________________________________________ Atty. No.: ___________________ Attorney (or Pro Se Petitioner): Pro Se 99500 Name: _____________________________________________ Address: ____________________________________________ City/State/Zip: _______________________________________ Telephone: __________________________________________ Primary Email: _______________________________________ Secondary Email: _____________________________________ Tertiary Email: ______________________________________ 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 Page 1 of 1