(Rev. 2/22/01) CCTR 0129 A (This form replaces CCMD-129) IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS MUNICIPAL DISTRICT ___________ ____________________________________________________ Plaintiff vs No. _________________________________ ____________________________________________________ Defendant MOTION PURSUANT TO CIRCUIT COURT RULE 11.3 FOR CONSIDERATION OF SUPERVISION Now comes defendant ______________________________________________________________ and requests this court to enter a sentence of supervision in this matter and in support thereof states under oath as follows: 1. That the defendant is prepared to stipulate to the facts alleged in the complaint. 2. That the defendant (refused to take) (took) a blood alcohol test. The result was _______________________________________________________________________________. 3. A copy of the defendant's internal driving abstract for the previous five (5) years is available to the Court. 4. A copy of police report and Alcohol Influence Report prepared on this charge is available to the Court. 5. A copy of defendant's alcohol or drug evaluation is available to the Court. 6. That the defendant has never been arrested in this or any other Jurisdiction for any alcohol or drug related driving offense except as follows: (State dispositions, if any) ____________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ______________________________________________________________________________________________ 7. If a traffic accident occurred at the time the citation was issued, complete the following: (a) Amount of Property Damage $ _____________________________________________________________ (b) Nature and extent of Personal Injury ____________________________________________________________ _____________________________________________________________________________________________ (c) Fatality involved YES q NO q (OVER) (Rev. 2/22/01) CCTR 0129 B 8. That defendant states a supervision order is in the best interest of defendant and his/her family for the following reasons: (State other matters in mitigation) ___________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ 9. That defendant states a supervision order is in the best interest of the public for the following reasons:____________________________________________________________________________________ ___________________________________________________________________________________________ _________________________________________________________________________________________. Dated: _____________________________, ________ _____________________________________________ Defendant _____________________________________________ Address _____________________________________________ City/State/Zip Subscribed to and sworn before me on this ________________ day of ______________________________, ________ _____________________________________________ Notary Public 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