Print Form ‰ 4572 ‰ 4406 - Case set on Progress Call Supportive Services Referral Order Clear Form (Rev. 10/12/11) CCDR 0037 A IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS COUNTY DEPARTMENT, DOMESTIC RELATIONS DIVISION IN RE THE ‰ MARRIAGE ‰ CIVIL UNION ‰ CUSTODY ‰ VISITATION ‰ PARENTAGE OF NO: ________________________________________________ CALENDAR: ____________________________ _____________________ PETITIONER ‰ PRE-JUDGMENT AND ________________________________________________ ‰ POST JUDGMENT RESPONDENT OFFICE OF ADOPTION AND CHILD CUSTODY REFERRAL ORDER IT IS HEREBY ORDERED that the matter is referred as follows: A. Office of Adoption and Child Custody Advocacy; Cook County Administrative Building, 69 W. Washington, Suite 818, Chicago, IL 60602; Telephone (312) 603-0550 Fax: (312) 603-9909 For ‰ Petitioner ‰ Respondent B. For the following: ‰ Home visit ‰ in Cook County ‰ out of Cook County ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ‰ School Records (please provide name and address of school) ________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ‰ _________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ‰ Monitoring (not to exceed one visit per month during a six (6) month period) Emergency __________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ (OVER) DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS (Rev. 10/12/11) CCDR 0037 B C. Identification of Children, Parties, Attorneys and Child Representatives: Child(ren)’s Full Name(s) D.O.B. Party with whom Child(ren) Resides ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ Petitioner: Petitioner’s Attorney: Name: _______________________________________ Atty. No. _______________ Address: _____________________________________ Name: _____________________________________________ ____________________________________________ Address: _______________________________________ Date of Birth: _________________________________ ______________________________________________ Telephone (H): ________________________________ Telephone: ______________________________________ (W): ________________________________________ FAX: _______________________________________ Respondent: Respondent’s Attorney: Name: _______________________________________ Atty. No. _______________ Address: _____________________________________ Name: _______________________________________ ____________________________________________ Date of Birth: _________________________________ Telephone (H): ________________________________ (W): ________________________________________ Address: _______________________________________ ______________________________________________ Telephone: ______________________________________ FAX: __________________________________________ Child(ren)’s Representative/Guardian ad Litem/Attorney for Child: Atty. No. _______________ Name: _______________________________________ Address: _____________________________________ ____________________________________________ Telephone: ___________________________________ FAX: ________________________________________ D. This matter is set for status on ______________________________ at _________ m. in Room _________ (Status date should not be set prior to 67 days from the date of this Order.) **The Court must fax this Order to the Office of Adoption and Child Custody Advocacy at (312) 603-9909. Atty. No.:__________________ Name: ____________________________________ ENTERED: Atty. for: ____________________________________ Address: ____________________________________ Dated: ______________________________, ___________ City/State/Zip: ________________________________ Telephone: __________________________________ _____________________________________________ Judge Judge’s No. FAX: ____________________________________ DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS