IN THE CIRCUIT COURT OF THE TWENTY-THIRD JUDICIAL CIRCUIT DEKALB COUNTY, ILLINOIS __________________________________ ) ) CASE NO. ______________________________ _______________________________ Petitioner(s), vs. __________________________________ __________________________________ Respondent(s). ) ) ) ) ) ) ) Petition for the Adoption of a Child Named: _______________________________________ CERTIFICATE OF MAILING I, ________________________________________ (Deputy) Clerk of the Circuit Court of the County of DeKalb and State of Illinois, do hereby certify that on the __________ day of ________________________, ________, I deposited in the United States mail at ___________, Illinois, a true copy of the Publication Notice in said cause hereto attached, enclosed in an envelope properly sealed, postage prepaid and correctly addressed, to each of the following-named persons at the respective address shown opposite each name: NAME RESIDENCE ADDRESS ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ I further certify that said mailing was made with ten (10) days of the publication of said notice. WITNESS the hand of said Clerk and the seal of said Court hereto affixed this date ________________________________. ___________________________________________________ (Clerk) Certificate of Mailing Rev. 04-01-16 American LegalNet, Inc. www.FormsWorkFlow.com