STATE OF ILLINOIS IN THE CIRCUIT COURT OF THE ELEVENTH JUDICIAL CIRCUIT FORD/MCLEAN COUNTY Plaintiff, vs. Defendant. ) ) ) ) ) ) ) ) ) Case No. SUPREME COURT RULE 222 ARBITRATION DISCLOSURE STATEMENT Instructions: Complete this disclosure statement using all information available to you within the time specified in Supreme Court Rule 222(c) and as set forth by local rule, or as the Court may order. File this Disclosure Statement with the Circuit Clerk and provide a copy to every other party to the action. You are under a continuing duty to disclose. You must seasonably supplement or amend this disclosure statement whenever new or different information or documents become known to you. All disclosures shall include information and data in the possession, custody and control of the parties, as well as that which can be ascertained, learned or acquired by reasonable inquiry and investigation. Each disclosure must be accompanied by a completed Affidavit re Disclosure. Each party shall disclose in writing to every other party: 1. The factual basis of the claim or defense. If multiple claims or defenses, the factual basis for each claim or defense. 2. The legal theory upon which each claim or defense is based including, where necessary for a reasonable understanding of the claim or defense, citations for pertinent legal or case authorities. 3. Names, addresses and telephone numbers of any witnesses you expect to call at the arbitration hearing/trial, including the subject matter on which they will testify. American LegalNet, Inc. www.USCourtForms.com 4(a). Names, addresses and telephone numbers of all persons whom the party believes may have knowledge or information relevant to events, transactions or occurrences that gave rise to the action. 4(b). The nature of the knowledge or information each such individual is believed to possess. 5. Names, addresses and telephone numbers of all persons who have given statements, whether written or recorded, signed or unsigned, and the custodian of the copies of those statements. 6. Names, addresses and telephone numbers of each person you expect to call as an opinion witness at the arbitration hearing/trial; the subject matter of their testimony; their conclusions and opinions and basis therefore; their qualifications; and, copies of any reports prepared by them. 7. A computation and the measure of damages you allege; the document or testimony on which the computation and measure are based; and, the names, addresses and telephone numbers of all damage witnesses. 8. The existence, location, custodian and general description of any tangible evidence or documents that you plan to use at the arbitration hearing/trial and relevant insurance agreements. 9(a). A list of documents (if voluminous documents, a list of the categories of documents) you know to exist (whether or not in the party's possession, custody or control) which may be relevant to the subject matter of the action and which appear reasonably calculated to lead to discovery of admissible evidence. 9(b). The dates when these documents will be made or have been made available for inspection and copying. American LegalNet, Inc. www.USCourtForms.com For service on all other parties ATTACH A COPY OF EACH DOCUMENT LISTED TO THIS DISCLOSURE STATEMENT as it is kept in the usual course of business. If production is not made, list the name and address of the document's custodian. DO NOT ATTACH COPIES OF DOCUMENTS TO THE DISCLOSURE STATEMENT WHICH YOU FILE WITH THE COURT. AFFIDAVIT OF DISCLOSURE STATE OF ILLINOIS ) ) SS COUNTY OF FORD/MCLEAN ) , being first duly sworn, on oath deposes and states that (s)he has read the foregoing Disclosure statement and that (s)he knows the contents thereof and that the same are complete and correct as of the date of this disclosure and that all reasonable attempts to comply with the provisions of Illinois Supreme Court Rule 222 have been made. Attorney/Party for Plaintiff/Defendant Address Telephone SUBSCRIBED AND SWORN TO before me this day of , 20 . NOTARY PUBLIC CERTIFICATE OF SERVICE I certify that on , 20 , I served this Arbitration Disclosure Statement by mailing a copy of the same to each party of this action and deposited the same in the U.S. Mail at Before p.m. on this date with proper postage prepaid. By: SUBSCRIBED AND SWORN TO before me this day of , 20 . NOTARY PUBLIC American LegalNet, Inc. www.USCourtForms.com STATE OF ILLINOIS IN THE CIRCUIT COURT OF THE ELEVENTH JUDICIAL CIRCUIT FORD/MCLEAN COUNTY ) ) ) ) ) ) ) ) ) Plaintiff, vs. Defendant. Case No. NOTICE OF DISCLOSURE TO: PLEASE TAKE NOTICE that on the of , 20 , we served upon every other party to this action named herein, a copy of Supreme Court Rule 222 Disclosure Statement, by mail and that a copy of this Notice has been filed with the Clerk of the Circuit Court, Ford/McLean County, Illinois. By: SUBSCRIBED AND SWORN TO before me this day of , 20 . NOTARY PUBLIC American LegalNet, Inc. www.USCourtForms.com