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 #: (to be completed by Court) 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)  Notice to School Board(s) (if remedy #4 is requested) SUMMONS – CIVIL NO CONTACT ORDER 740 ILCS 22/101 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, Room 18 N. County Street , located at , Waukegan (Street address) LAKE County Courthouse, , Illinois, within 7 days after the service of this (City) summons, not counting the day of service. IF YOU FAIL TO DO SO, A CIVIL NO CONTACT ORDER MAY BE ENTERED AGAINST YOU BY DEFAULT FOR THE RELIEF ASKED IN THE PETITION. Hearing Date: Time: m. Courtroom To the Officer: The Officer, or other person to whom it was given for service, with endorsement of service immediately following service, must return this summons. If service cannot be made, this summons shall be returned so endorsed. This summons may not be served later than 30 days after its date. DATED Petitioner’s Attorney or Petitioner (if not represented by an attorney) Name: Phone(s): Address: City/State/Zip: Clerk of the Circuit Court Deputy Clerk Page 1 of 2 – Summons - Civil No Contact Order 171-341 (R 01/10) American LegalNet, Inc. www.FormsWorkFlow.com SERVICE  I certify that I served this summons 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. Name of Respondent: Time: Date of Service: Name of Person Summons given to: Sex: Race: Approximate Age: Date of Mailing: Place of Service:  Respondent not found in this County. at  Service by mailing notice, postage, fully pre-paid on (date) and addressed to (Place of mailing) , (Respondent’s name) , (Street) m, from , (City) . (State) (S.Ct. Rule 11 (b)(3) and 12(b)(3). Service is complete four days after mailing) (Zip Code) .  I certify that Respondent was served while incarcerated at: Sheriff By Deputy Date: Page 2 of 2 – Summons - Civil No Contact Order 171-341 (R 01/10) American LegalNet, Inc. www.FormsWorkFlow.com