Print Form Agreed Petition for Refund of Fees Collected Clear Form (Rev. 7/11/08) CCG 0052 IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS ______________________________________________________ v. ______________________________________________________ } No. _____________________________ AGREED PETITION FOR REFUND OF FEES COLLECTED I, _____________________________________________, hereby petition this honorable Court to order the refund of certain fees and costs collected by the Clerk of the Circuit Court of Cook County. ________________________________________________ delivered $ ______________________________ in payment of fees and/or costs to the Clerk of the Circuit Court in payment of __________________________________________________ on ___________________________________, _________. It has been determined that $ ___________________ of this payment was not due and owing to the Clerk of the Circuit Court. The petitioner hereby declares that the foregoing statements to be true and accurate. ____________________________________________ By ____________________________________________ ORDER It is therefore ordered DOROTHY BROWN, Clerk of the Circuit Court pay to ______________________________ the amount of $ ______________________________ as a refund of the fees and/or costs. Atty. No.:__________________ Name: ______________________________________________ ENTERED: Atty. for: __________________________________________ Address: __________________________________________ _____________________________________, _________ City/State/Zip: ______________________________________ Telephone: ________________________________________ _______________________________________________ Judge Judge's No. DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS