STATE OF ILLINOIS IN THE CIRCUIT COURT OF THE 22nd JUDICIAL CIRCUIT McHENRY COUNTY _______________________________________________ Plaintiff Arbitration Case Number________________________________ vs. _______________________________________________ Defendant NOTICE OF REJECTION OF AWARD To:__________________________________________________________________________________ _____________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ NOTICE MUST BE SENT TO THE CLERK OF THE CIRCUIT COURT AND TO ALL PARTIES OF RECORD. PAYMENT OF THE REJECTION OF AWARD FEE MUST ACCOMPANY THE FILING OF THIS NOTICE. The Rejection of Award fee is $200.00 for awards of $30,000 or less, or $500.00 for awards of more than $30,000. NOTICE IS GIVEN THAT ____________________________________________________rejects the Plaintiff/Defendant Award of the Arbitrators entered in this cause on _____________________________________________ and requests a trial before the Court. Parties shall appear on the date previously scheduled on the Notice of Award to set a date for trial. ___________________________________________ Signature of Rejecting Party or Attorney Name__________________________________________________ Attorney for_____________________________________________ Address_________________________________________________ City, State Zip____________________________________________ Phone___________________________________________________ Received ____________________________________________________, 20_______, at _______ ___.M. PAGE TWO MUST BE COMPLETED CLERK OF THE 22nd JUDICIAL CIRCUIT COURT McHENRY COUNTY, WOODSTOCK, ILLINOIS 60098 CV-NOT6: Revised 12/01/06 Page 1 of 2 American LegalNet, Inc. www.FormsWorkflow.com CERTIFICATE OF ATTORNEY I certify that on ______________________________________________________, 20_____, I served this notice by mailing a copy to each person to whom it is directed. ___________________________________________________ Attorney’s Signature AFFIDAVIT OF SERVICE ______________________________________________________________________ on oath states; On ________________________________________________, 20________, I served this notice by mailing a copy to each person to whom it is directed. ___________________________________________________ Signature Signed and sworn to before me ____________________________________, 20____ ___________________________________________ Notary Public CV-NOT6: Revised 12/01/06 Page 2 of 2 American LegalNet, Inc. www.FormsWorkflow.com