CIRCUIT COURT OF ILLINOIS NINETEENTH JUDICIAL CIRCUIT LAKE COUNTY Petitioner’s Name (person completing form) Name(s) of other protected parties  Independent  Criminal  Juvenile Check if filing on behalf of: (file stamp)  a minor child, or  an adult who because of age, disability, health, or inaccessibility cannot file the petition (list name(s) below) vs. Respondent’s Name (person you want protection from) If the Respondent is under age 18 and if remedy #4 is requested the name(s) of minor  parent(s) or  legal guardian(s) Case #: (to be completed by Court)  Notice to School Board (s) (if remedy #4 is requested) MOTION TO EXTEND AND/OR MODIFY CIVIL NO CONTACT ORDER be I request that the  Emergency or  Plenary Civil No Contact Order issued on  extended OR  modified OR  extension to remain in effect until the order is vacated or modified for the following good cause: 1. Extension when there has been no material change in relevant circumstances 740 ILCS 22/216(c).  This motion is not contested and the petitioner seeks no modification of the order. The reasons for the extension are: 2. Modification or Extension when there is a material change in relevant circumstances.  There has been a material change of relevant circumstances since the order was issued. The changes of relevant circumstances and the reason for the requested modification or extension are as follows: The Petitioner requests the following modification: 3.  Extension requested until the order is vacated or modified for the following good cause: Form approved by the Conference of Chief Circuit Judges. Effective December 11, 2009 Use required after January 1, 2010 Page 1 of 3 – Motion to Extend and/or Modify Civil No Contact Order 171-384 (R 01/10) American LegalNet, Inc. www.FormsWorkFlow.com  Respondents address is unknown. Service by publication is requested. (Sec. 2-206 (a) of the Code of Civil Procedure) The Petitioner prays this motion be set for hearing. VERIFICATION UNDER THE 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, EXCEPT AS TO MATTERS HEREIN STATED TO BE ON INFORMATION AND BELIEF AND AS TO SUCH MATTERS THE UNDERSIGNED CERTIFIES AS AFORESAID THAT THE UNDERSIGNED VERILY BELIEVES THE SAME TO BE TRUE. Signature of Petitioner Petitioner’s Attorney or Petitioner (if not represented by an attorney) Name: Phone(s): Address: City/State/Zip: Petitioner's current address: (Street/P.O. Box) (City) (State) (Zip Code)  Disclosure of Petitioner’s and/or protected party’(s) address would risk further abuse. The address listed above is Petitioner’s and/or protected party’(s) alternative address for service of notice. ORDER Cause set for  status call  hearing on at , at m. in Courtroom County Courthouse, located at , 20 . day Dated at Waukegan, Illinois this of , 20 . Enter: Judge SERVICE  I certify that I served this Motion on Respondent as follows: (Check appropriate box, and complete information below.)  Individual Respondent – Personal By leaving a copy and a copy of the complaint with named Respondent . personally on  Individual Respondent-Abode By leaving a copy and a copy of the complaint at the usual place of abode of named Respondent with a person of his family, of the age of 13 years or upwards, informing that person of the contents and also sending a copy of the summons in a sealed envelope with postage fully prepaid, addressed to named Respondent at his usual place of abode. Page 2 of 3 – Motion to Extend and/or Modify Civil No Contact Order 171-384 (R 01/10) American LegalNet, Inc. www.FormsWorkFlow.com Name of Respondent: Date of Service: Time: Name of Person Summons given to: Sex: Race: Approximate Age: Date of Mailing: Place of Service:  Respondent not found in this County.  Service by mailing notice, postage, fully pre-paid on and addressed to at (date) (Respondent’s name) , , (Street) (City) (State) (S.Ct. Rule 11 (b)(3) and 12(b)(3). Service is complete four days after mailing) m, from , (Place of mailing) . (Zip Code) .  I certify that Respondent was served while incarcerated at: Sheriff By Deputy Date:  I certify that a copy of the Motion to Extend and/or Modify the Civil No Contact Order was served on the respondent by mailing in an envelope addressed to respondent at respondents’ last known address with postage full prepaid and by depositing said envelope in a U.S. Post Office mail box on: . (date) Petitioner Page 3 of 3 – Motion to Extend and/or Modify Civil No Contact Order 171-384 (R 01/10) American LegalNet, Inc. www.FormsWorkFlow.com