171 - 23b ( Rev. 12 /1 7 ) IN THE CIRCUIT COURT OF THE NINETEENTH JUDICIAL CIRCUIT LAKE COUNTY, ILLINOIS ) ) ) Plaintiff(s) ) vs. ) ) ) ) Gen No . Defendant(s) ) CERTIFICATE OF JUDGMENT CREDITOR OR AT TORN E Y IN CITATION PROCEEDINGS I, the undersigned judgment creditor or attorney for the judgment creditor certify under penalties as provided by law pursuant to section 1 - 109 of the Code of Civil Procedure of the Illinois Compiled Statutes that the statem ent set forth in this instrument are true and correct. 1. That judgment was entered on in the Circuit Court of Lake County in the State of Illinois. (date) 2. The case number of that proceeding is . 3. The amount of Judgment $ (a) Allowable costs pr eviously expended $ (b) Filing and summons costs of prior supplementary proceedings $ (c) Filing and service costs for this citation proceeding $ (d) Interest on Judgment to this date $ TOTAL $ DEDUCT: Total amount paid by or on behalf of judgment debt or prior to this citation $ BALANCE DUE JUDGMENT CREDITOR $ Judgment Creditor or Attorney Dated this day of , 20 . Prepared by: Name: Pro Se Address: City: State: Pho ne: Zip Code: ARDC #: E - mail address: American LegalNet, Inc. www.FormsWorkFlow.com