7288, 7289 - Order Referred to FOCUS 4578 - Order Referred to MFCS 4572 - Order Referred to DSS 4616 - Order Referred to FCSD 4574 - Order Referred for Report to Court Print Form Clear Form (Rev. 9/26/11) CCDR 0009 A IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS COUNTY DEPARTMENT, DOMESTIC RELATIONS DIVISION IN RE THE: MARRIAGE CIVIL UNION VISITATION CUSTODY NO: ____________________________ PARENTAGE OF ______________________________________________________ CALENDAR:_______________________ PETITIONER PRE-JUDGMENT AND ______________________________________________________ POST JUDGMENT RESPONDENT CIRCUIT COURT RULE 13.4(f) CONSOLIDATED REFERRAL ORDER: CONTESTED CUSTODY/VISITATION EDUCATIONAL PROGRAM, ILLINOIS MARRIAGE AND DISSOLUTION OF MARRIAGE ACT THIS MATTER having been represented as involving custody and/or visitation of the child(ren) of the parties, IT IS HEREBY ORDERED that the matter is referred as follows: A. TYPE OF REFERRAL AND AGENCY FOCUS ON CHILDREN parent education program (FOCUS); Cook County Administration Building, Suite 1000, 69 W. Washington, 10th Floor, Chicago, IL 60602; Telephone: (312) 603-1550 FAX: (312) 603-1588 or Suburban Municipal District ________ located at ____________________________________________________ For Petitioner Respondent Focus Class in Spanish 7288 7289 Focus on Children fee assessed for attendance, to be collected by the Clerk of the Circuit Court of Cook County is: $25.00 4578 $ Set at ____________ Waived To be paid by Petitioner Respondent Marriage and Family Counseling Service (MFCS); Cook County Administration Bldg., Suite 1000, 69 W. Washington, Chicago, IL 60602; Telephone: (312) 603-1540 FAX: (312) 603-9842 or Suburban Municipal District ________ located at _________________________________________________ For Mediation Conciliation Reconciliation Emergency Intervention Nature of Emergency: ______________________________________________________________________ ISSUE(S): _______________________________________________________________________________ __________________________________________________________________________________ Please check if applicable: FOCUS ON CHILDREN IS A PRECONDITION TO MEDIATION. The parties and their attorneys are ordered to contact MFCS immediately when Emergency Intervention has been ordered. 4572 Office of Adoption and Child Custody Advocacy; Cook County Administration Bldg., Suite 818, 69 W. Washington, Chicago, IL 60602; Telephone: (312) 603-0550; Fax: (312) 603-9909 (contact Social Services Coordinator) For General Study Specific Study Other ISSUE(S): ______________________________________________________________________________ __________________________________________________________________________________ (Page 1 of 3) (Rev. 9/26/11) CCDR 0009 B Forensic Clinical Services Department (FCSD); 69 W Washington, Suite 1000, Chicago, IL 60602; 4616 Telephone: (312) 603-1584 FAX: (312) 603-9842 (contact Administrator-Domestic Relations Program) ISSUE(S):__________________________________________________________________________________ __________________________________________________________________________________ Private resources for Mediation Evaluation Other 4574 Name: __________________________________________________________________________________________________________ Address: ________________________________________________________________________________________________________ Telephone and Contact: ________________________________________________________________________________________ Costs shall be paid by: _____________________________________________________________________________________________ ISSUE(S):__________________________________________________________________________________ __________________________________________________________________________________ B. SPECIAL CONSIDERATIONS Pending DCFS Investigation C. Order of Protection Shelter Care Other Pending Proceedings Identification of Parties, Children, Attorneys Child(ren)’s Full Name(s) Age Date of Birth Residential Address ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ Petitioner’s: Petitioner’s Attorney: Name: __________________________________________________ Name: ______________________________________ * Address: _______________________________________________ Address: ____________________________________ ________________________________________________________ Date of Birth: ___________________________________________ Tel. No:(H) _____________________________________________ (W) ____________________________________________________ _____________________________________________ Tel. No: ____________________________________________ Fax:___________________________________________________ Respondent: Respondent’s Attorney: Name: __________________________________________________ Name: ______________________________________ * Address: _______________________________________________ Address: ____________________________________ ________________________________________________________ Date of Birth: ___________________________________________ Tel. No:(H) _____________________________________________ (W) ____________________________________________________ _____________________________________________ Tel. No: ____________________________________________ Fax:___________________________________________________ (Page 2 of 3) (Rev. 9/26/11) CCDR 0009 C Other: Attorney: Name: __________________________________________________ Name: ______________________________________ * Address: _______________________________________________ Address: ____________________________________ ________________________________________________________ Date of Birth: ___________________________________________ Tel. No:(H) _____________________________________________ (W) ____________________________________________________ _____________________________________________ Tel. No: ____________________________________________ Fax:___________________________________________________ Child’s Representative/Guardian Ad Litem/Attorney for Child Name: __________________________________________________ Address: _______________________________________________ Telephone: ______________________________________________ Fax:____________________________________________________ D. Unless otherwise provided by court order, all Forensic Clinical Services Department (FCSD) evaluations, Office of Adoption and Child custody Advocacy, reports and reports or evaluations for Private Resources shall be in writing and sent to the Court and all attorneys of record 10 days prior to the date set forth in paragraph E below. E. This matter is set for status on ______________________________________ at _______________ m. in Room ____________ at the courtroom located at ________________________________________. The parties and their attorneys shall appear. F. For all referrals, except emergency intervention, the attorney for ________________________________________ shall contact the referred agency within 10 days of the entry of this o der and transmit all appropriate pleadings with this order within 10 days of the entry of this order. All parties shall promptly and fully comply with the requirements of any referred agency. Atty. Code No. _______________ Name: ________________________________________ Attorney for: _____________________________________ ENTERED: Address: ________________________________________ City/State/Zip: ___________________________________ Dated: ________________________, __________ Telephone: ______________________________________ Fax: ___________________________________________ ________________________________________ Judge Judge’s No. *If a party has not disclosed an address, that party shall designate an alternative address for the purpose of notice. (Page 3 of 3) DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS