IN THE CIRCUIT COURT OF THE TWENTY-SECOND JUDICIAL CIRCUIT McHENRY COUNTY, ILLINOIS ____________________________________ vs. _____________________________________ ) ) ) ) ) Case Number ____________________________ CERTIFICATE CHILD CUSTODY PROCEEDING Pursuant to McHenry County Administrative Order 2006-10 and in compliance with Illinois Supreme Court Rules 902 & 903, I hereby certify that: The child/children involved in this Complaint or Petition is/are NOT the subject of any other child custody proceeding pending before another division of the Circuit Court, or another court or administrative body of Illinois, or of any other state, an Indian tribe, or a foreign country. The child/children involved herein is/are the subject of another child custody proceeding pending before another division of the Circuit Court, or another court or administrative body of Illinois, or any other state, an Indian tribe, or a foreign country. That case or cases is/are assigned case number__________________ which is/are assigned to The Honorable ________________________ in ______________________ County, State of _________________________________. The parties to this action are _______________________________________________________________________. An Order affecting the custody or visitation of the Child/Children has been entered by the Circuit Court of ____________________________, County ___________________, State of ____________________________, on ______________________________. MONTH/DAY/YEAR In accordance with Illinois Supreme Court Rule 137, the undersigned certifies that to the best of his/her knowledge, information and belief, formed after reasonable inquiry, that the information contained in this Certificate is true and correct. The undersigned hereby further acknowledges that the parties have a continuing duty to disclose information relating to other pending child custody proceedings or any existing orders affecting the custody or visitation of the child, and shall immediately disclose to the Court and other parties to the proceedings any such information obtained after the initial pleadings, answer or appearance. _____________________________________________________ Prepared by ____________________________________ Attorney for ____________________________________________ Attorney for Petitioner ____________________________________ Address ____________________________________ _____________________________________________ Individual Pro-se Litigant City, State Zip ____________________________________ Telephone _____________________________________________ Agent CV-CRT5: 12/01/06 American LegalNet, Inc. www.FormsWorkflow.com