IN THE CIRCUIT COURT FOR THE THIRD JUDICIAL CIRCUIT MADISON COUNTY, ILLINOIS CERTIFICATION OF JUDGMENT BALANCE Employer Name: Address: City, State: RE: Creditor: Defendant: Case No. Balance Due at End of Last Quarter: Pursuant to the Illinois Code of Civil Procedure, Section 12/808.5, the undersigned hereby certifies that the above-stated amount is the balance due on the judgment as of the last day of the last calendar quarter. Please note that the law requires the employer to hand deliver or mail by First Class Mail, a copy of this certification to the judgment debtor at the judgment debtor's last known address. Attorney for Judgment Creditor or Pro Se Creditor Employer copy American LegalNet, Inc. www.FormsWorkFlow.com