‰ 4343 - Voluntary Enrollment in Alcohol Monitoring Program Petitioner - Allowed ‰ 4344 - Voluntary Enrollment in Alcohol Monitoring Program Respondent - Allowed ‰ 4406 - Case set on Progress Call Voluntary Order for Enrollment in Alcohol Monitoring Program Print Form Clear Form (9/28/11) CCDR 0056 A IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS COUNTY DEPARTMENT, DOMESTIC RELATIONS DIVISION In re the: ‰Marriage ‰ Visitation ‰Custody ‰Civil Union ‰ ‰ P arentage of ____________________________________________________ Petitioner No. ______________________________________ Calendar ____________________________________ and ‰ Pre-Judgment ____________________________________________________ Respondent ‰ Post Judgment VOLUNTARY ORDER FOR ENROLLMENT IN ALCOHOL MONITORING PROGRAM THIS CAUSE being properly before the Court, and the Court being advised in the premises, and the Petitioner/Respondent voluntarily submitting to alcohol monitoring; IT IS HEREBY ORDERED that: 1. _______________________________________________________________________________________ (Name of Company) (Address) (Telephone/FAX) is designated as the alcohol monitoring program for ‰ Petitioner ‰ Respondent. 2. Petitioner/Respondent is hereby ordered to contact the above monitoring company within 24 hours of this Order to enroll in the alcohol monitoring program. 3. Petitioner /Respondent shall participate in the alcohol monitoring program as follows: ________________________________________________________________________________________ ________________________________________________________________________________________ 4. ‰ The Court finds that the parties have limited financial means and qualify for the program's sliding scale fee schedule. ‰ The Court finds that the parties have sufficient resources to pay the program's costs. 5. The costs for Petitioner’s/Respondent’s participation shall be paid __________ % by Petitioner and __________ % by Respondent. 6. The monitoring company shall provide copies of any and all results to the Court, to pro se litigant(s) and to all attorney(s) of record. (OVER) DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS (9/28/11) CCDR 0056 B 7. Identification of Parties, Attorneys and Child Representatives: Petitioner: Petitioner’s Attorney: Name: _______________________________________ Atty. No. ______________ Address: _____________________________________ Name: _____________________________________________ _____________________________________________ Date of Birth: _________________________________ Telephone (H): ________________________________ (W): ________________________________________ Address: _______________________________________ Respondent: Respondent’s Attorney: ______________________________________________ Telephone: ______________________________________ FAX: _______________________________________ Name: _______________________________________ Atty. No. ______________ Address: _____________________________________ Name: __________________________________________ _____________________________________________ Date of Birth: _________________________________ Telephone (H): ________________________________ (W): ________________________________________ Address: _______________________________________ ______________________________________________ Telephone: ______________________________________ FAX: ___________________________________________ Child(ren)’s Representative/Guardian ad Litem/Attorney for Child: Name: _______________________________________ Address: _____________________________________ _____________________________________________ Telephone: ___________________________________ FAX: ________________________________________ 8. This matter is set for status on _______________________________ at _________ m. in Room _________. ‰ 4406 _____________________________________________ ______________________________________________ Petitioner’s Signature Date Respondent’s Signature Date Atty. No.:__________________ ____________________________________ Atty. for: ____________________________________ ENTERED: Address: ____________________________________ Dated: ______________________________, ___________ City/State/Zip: __________________________________ Telephone: __________________________________ _____________________________________________ FAX: ____________________________________ Judge Judge’s No. Name: DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS