CIRCUIT COURT OF ILLINOIS NINETEENTH JUDICIAL CIRCUIT LAKE COUNTY  Independent  Criminal  Juvenile Petitioner’s Name (person desiring protection) Name(s) of other protected parties Check if filing on behalf of:  a minor child, or  an adult who because of age, disability, health, or inaccessibility cannot file the petition (list name(s) below) (file stamp) Case #: vs. (to be completed by Court) LEADS#: 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)  Notice to School Board(s) (if remedy #4 is requested) Respondent’s Date of Birth: ORDER FOR EXTENSION AND/OR MODIFICATION CIVIL NO CONTACT ORDER The court finds that:  an emergency order  a plenary order , was entered on .  Notice of hearing has been served pursuant to Supreme Court Rules 11(b)(3)412(b)(c). 740 ILCS 22/209. The court having jurisdiction of the subject matter and the parties, it is hereby ordered that:  1. An extension of the  emergency order is granted and is hereby extended to  plenary order 20 at M.  2. Upon good cause being shown, an extension of the plenary order is granted and is hereby to remain in effect until vacated or modified. 740 ILCS 22/216 (d-5)  3. A hearing on the  emergency order  plenary order is set for at M., at , 20 LAKE County Courthouse, Courtroom 18 N. County Street , Waukegan , , Illinois.  4. The  emergency order  plenary order is vacated.  5. The  emergency order  plenary order is modified as follows: Dated at Waukegan, Illinois this of , 20 day Enter: . Judge  Petitioner  Respondent given a copy of this Order in open court on , 20 . cc:  Petitioner  Respondent  Counsel of Record  Sheriff  Advocate  Jail  State’s Attorney  Involved School Board(s) (if remedy #4 is ordered) Form approved by the Conference of Chief Circuit Judges. Effective December 11, 2009 Use required after January 1, 2010 Page 1 of 1 – Order for Extension and/or Modification of Civil No Contact Order 171-383 (R 01/10) American LegalNet, Inc. www.FormsWorkFlow.com