WAIVER BY JURY TRIAL - PROBATE STATE OF ILLINOIS 3827 (Rev. 1/17) UNITED STATES OF AMERICA COUNTY OF DU PAGE IN THE CIRCUIT COURT OF THE EIGHTEENTH JUDICIAL CIRCUIT IN RE ESTATE OF CASE NUMBER ALLEGED DISABLED PERSON File Stamp Here Print the name of the Guardian Ad Litem for Respondent WAIVER OF TRIAL BY JURY NOW COMES the above named duly appointed Guardian Ad Litem for the Respondent in the above entitled cause of action, and on behalf of said Respondent, the right to trial by jury is hereby acknowledged and is hereby waived. WAIVER OF RESPONDENT'S PRESENCE NOW COMES the above named duly appointed Guardian Ad Litem for the Respondent in the above entitled cause of action, and on behalf of said Respondent, the right to be present in open Court is hereby knowledged and is waived. WAIVER OF DOCTOR'S PRESENCE NOW COMES the above named duly appointed Guardian Ad Litem for the Respondent in the above entitled cause of action, and on behalf of said Respondent, the right of the Doctor to be present in open Court is hereby acknowledged and is waived. WAIVER OF RIGHT TO COUNSEL NOW COMES the above named duly appointed Guardian Ad Litem for the Respondent in the above entitled cause of action, and on behalf of said Respondent, the right to counsel is hereby acknowledged and is hereby waived. Name: DuPage Attorney Number: Attorney for: Address: City/State/Zip: Telephone Number: Email: Pro Se Signature of Guardian Ad Litem CHRIS KACHIROUBAS, CLERK OF THE 18th JUDICIAL CIRCUIT COURT © WHEATON, ILLINOIS 60187-0707 American LegalNet, Inc. www.FormsWorkFlow.com