Print Form Clear Form 2877 Certification of Representation Filed (Rev. 10/29/14) CCG N642 IN THE CIRCUIT COURT OF THE COOK COUNTY, ILLINOIS ______________________________________ DEPARTMENT __________________________________________________________ v. No. ________________________________ __________________________________________________________ RULE 298 CERTIFICATION FOR WAIVER OF FEES REPRESENTATION BY CIVIL LEGAL SERVICES PROVIDER OR COURT-SPONSORED PRO BONO PROGRAM Pursuant to Supreme Court Rule 298, the undersigned counsel hereby certifies that s/he is an attorney for _________________________________________________________________________________________ , (name of organization or court program) a civil legal services provider or court-sponsored pro bono program as defined in 735 ILCS 5/5-105.5(a), and that _____________________________________________________________________________________ (name of organization or court program) has made the determination that ______________________________________________________________ (name of party) has income of 125% or less of the current official poverty guidelines or is otherwise eligible to receive services under the eligibility guidelines of the civil legal services provider or court-sponsored pro bono program. As a result, under Supreme Court Rule 298, _________________________________________________________ (name of party) is eligible to sue or defend without payment of fees, costs or charges as defined at 735 ILCS 5/5-105(a)(1). _____________________________________________ Attorney Certification Name of Organization or Court Program: ______________________________________________________________ Atty. No.: _________________________________________________________________________________________ Name: ____________________________________________________________________________________________ Address: __________________________________________________________________________________________ City/State/Zip Code: ________________________________________________________________________________ Telephone: ________________________________________________________________________________________ DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS Page 1 of 1