STATE OF ILLINOIS IN THE CIRCUIT COURT OF THE NINETEENTH JUDICIAL CIRCUIT LAKE COUNTY, COUNTY ) ) ) ) ) ) ) Vs. No. __________________________________ SUMMONS IN ADMINISTRATIVE REVIEW To the defendant: YOU ARE SUMMONED and required to file an answer in this case or otherwise file your appearance in the office of the clerk of this court in ____________________________________________________________, Illinois (Address) (City) within 35 days after the date of this summons. WITNESS, _______________________________, 20 _______. (Seal of Court) Name ________________________________________ Attorney for ___________________________________ Address ______________________________________ City _________________________________________ Telephone ____________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ CERTIFICATE OF MAILING On __________________________________, 20 ________, I sent by registered mail a copy of this summons to each defendant addressed as follows: Defendant ____________________________________________ ____________________________________________ ____________________________________________ ____________________________________________ Address _____________________________________________ _____________________________________________ _____________________________________________ _____________________________________________ Dated _____________________________, 20 _______. (Seal of Court) _____________________________________________ (Clerk of the Circuit Court) ___________________________________________________ (Clerk of the Circuit Court) 171-258 rev 2/02 American LegalNet, Inc. www.FormsWorkFlow.com