q 4343 - Voluntary Enrollment in Alcohol Monitoring Program Petitioner - Allowed q 4344 - Voluntary Enrollment in Alcohol Monitoring Program Respondent - Allowed q 4406 - Case set on Progress Call Voluntary Order for Enrollment in Alcohol Monitoring Program (Rev. 12/11/15) CCDR N056 A IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS COUNTY DEPARTMENT, DOMESTIC RELATIONS DIVISION IN RE: q Marriage q Civil Union q Legal Separation q Allocation of Parental Responsibilities q Visitation (Non-Parent) q Support q Parentage of: No.: ___________________________________ Calendar: ______________________________ q Pre-Judgment q Post-Judgment ______________________________________________________ Petitioner and ______________________________________________________ Respondent 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 q Petitioner q 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. q The Court finds that the parties have limited financial means and qualify for the program's sliding scale fee schedule. q 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. DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com (Rev. 12/11/15) CCDR N056 B 7. Identification of Parties, Attorneys and Child Representative: Petitioner: Name: ___________________________________________ Address: __________________________________________ City/State/Zip Code: ________________________________ Date of Birth: _____________________________________ Telephone (H): ____________________________________ (W): ____________________________________________ Respondent: Name: ___________________________________________ Address: __________________________________________ City/State/Zip Code: ________________________________ Date of Birth: _____________________________________ Telephone (H): ____________________________________ (W): ____________________________________________ Child(ren)'s Representative/Guardian ad Litem/Attorney for Child: Name: ___________________________________________ Address: __________________________________________ City/State/Zip Code: ________________________________ Telephone : _______________________________________ FAX : ___________________________________________ Petitioner's Attorney: Atty. No: _______________ Name: ___________________________________________ Address: __________________________________________ City/State/Zip Code: ________________________________ Telephone : _______________________________________ FAX : ___________________________________________ Respondent Attorney: Atty. No: _______________ Name: ___________________________________________ Address: __________________________________________ City/State/Zip Code: ________________________________ Telephone : _______________________________________ FAX : ___________________________________________ 8. This matter is set for status on _____________________ at _____________ m. in Room _______________ . q 4406 ___________________________________________ __________________________________________ Petitioner's Signature Date Respondent's Signature Date Atty. No: _______________ Name: ___________________________________________ Atty for: __________________________________________ Address: __________________________________________ City/State/Zip Code: ________________________________ Telephone : _______________________________________ FAX : ___________________________________________ Primary Email Address: _________________________________________________ Secondary Email Address: _________________________________________________ Other Email Address: Judge Judge's No. ENTERED: Dated: ___________________________________________ ___________________________________________ DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com