(Rev. 1/22/01) CCJ 0083 IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS JUVENILE JUSTICE AND CHILD PROTECTION DEPARTMENT JUVENILE JUSTICE DIVISION NOTICE OF RIGHT TO APPEAL Minor's Name __________________________________________________________________________________________________________ Address_______________________________________________________ Petition Number ______________________________________________ Judge _______________________________________________________ Address_______________________________________________________ Date of Commitment _____________________________ City/Zip ________________________________________ GAL or Private Attorney (if any) _____________________________________________________________________________________ City/Zip ________________________________________ Based upon evidence submitted to the Court, you have been found delinquent, made a ward of the Court, and you have been ordered committed to the Department of Corrections, Juvenile Division. You can appeal these findings and the commitment order to the Illinois Appellate Court. If you wish to appeal, fill out and mail the attached form to: CLERK OF THE CIRCUIT COURT - Juvenile Justice Division, 1100 South Hamilton Avenue, Chicago, Illinois 60612. PLEASE RETURN THIS REQUEST WITHIN 15 DAYS AFTER YOUR COMMITMENT REQUEST FOR APPEAL I have been committed to the Department of Corrections, Juvenile Division. I WISH TO APPEAL Please check the statement below which applies to your case. (Check only one) q I am without funds and unable to hire a lawyer or pay for a written record of what took place in court. I ask the court to give me a free written record of my case, and a lawyer to present my appeal and any other necessary motions for me. to my own lawyer. q I have a private lawyer to appeal my case and to present any other necessary motions for me. I ask the court to send this form Private Lawyer's Name ___________________________________ Address ________________________________________________ _______________________________________________________ (Sign your name) City ____________________ State __________ Zip __________ Under penalty of perjury, I swear that I am a minor respondent and that the above statements are true and correct. ________________________________________________________ (Signature of minor) Subscribed to and sworn to before me on this ____________ day of ____________________________________________, ________ _______________________________________________________ Notary Public * * * * * * TO BE COMPLETED BY PRIVATE ATTORNEY ONLY * * * * * * I hereby acknowledge receipt of this request for representation on appeal. I, _______________________________________________________________ q will Print Name q will not act on behalf of this minor. __________________________________________________________ Signature of Attorney Return form within 10 days to: CLERK OF THE CIRCUIT COURT Juvenile Justice Division, 1100 South Hamilton Avenue, Chicago, Illinois 60612. 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