#171 - 479 Rev 1 2 /1 7 ) IN THE CIRCUIT COURT OF THE NINETEENTH JUDICIAL CIRCUIT LAKE COUNTY, ILLINOIS ) ) ) Plaintiff(s) ) vs. ) ) ) ) Gen No . Defendant(s) ) NOTICE OF REJECTION OF AWARD TO THE CLERK OF THE CIRCUIT COURT : Notice is given that rejects the award of the arbitrators entered in this cause on 20 , and hereby r equests a trial of this action. I further mo re certify that I have paid the rejection fee of: $200.00 (For Awards equal to or less than $30,000.00) $500.00 (For Awards greater than $30,000.00) Signature PROOF OF SERVICE Under penalties of perjury as provided by law pursuant to Section 1 - 109 of the Code of Civil Procedure, the undersigned certifies that the statements set forth in this instrument are true and correct. On 20 , I on oath state that: I served this notice by delivering a copy personally to all parties of record. I served this notice by mailing a copy to all parties of record and depositing the same in the U.S. Mail at , Illinois, with the proper postage prepaid . Signature Prepared by: Name: Pro Se Address: City: State: Phone: Zip Code: ARDC #: E - mail address: PARTIES SHALL APPEAR ON THE DATE PREVIOUSLY SCHEDULED ON THE NOTICE OF AWARD TO SET A DATE FOR TRIAL American LegalNet, Inc. www.FormsWorkFlow.com