2877 Cert. of Representation Filed (Rev. 1/5/01) CCG 0642 IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS _______________ DEPARTMENT No. _____________________________ REPRESENTATION BY CIVIL LEGAL SERVICES PROVIDER I, _______________________________________, a civil legal services provider as defined by statute have (attorney's name) determined that __________________________________ is eligible to have all fees relating to filing, appearing, (name of client) transcript on appeal, and service of process waived because _________________________________'s income is (name of client) 125% or less of the current official federal poverty income guidelines, or __________________________________ is otherwise eligible to receive civil legal services under the Legal Services Corporation Act of 1974. _____________________________________________ Attorney Certification Civil Legal Services Provider: __________________________________ Attorney Name ______________________________________________ Attorney No. ________________________________________________ Address ____________________________________________________ City, State, Zip_______________________________________________ Telephone __________________________________________________ DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS Print This Form For your protection and privacy, please press the Clear This Form button after you have printed the form. Clear This Form