STATE OF ILLINOIS ) )SS COUNTY OF WILL ) APPEAL TO THE THIRD DISTRICT APPELLATE COURT IN THE CIRCUIT COURT OF THE TWELFTH JUDICIAL CIRCUIT WILL COUNTY, ILLINOIS _______________________________________ Plaintiff vs CASE NO: ______________________________ _______________________________________ Defendant NOTICE OF APPEAL An appeal is taken from the order of judgment described below: COURT TO WHICH APPEAL IS TAKEN: Third District Appellate Court 1004 Columbus Street Ottawa, Illinois 61350 NAME AND ADDRESS OF APPELLANT ON APPEAL: Name: _______________________________________________________________ Address: _____________________________________________________________ _____________________________________________________________ Phone: _______________________________________________________________ DATE OF JUDGMENT OR ORDER: ______________________ JUDGE: _________________________ NATURE OF ORDER APPEALED FROM: __________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ ______________________________ (Signature) The undersigned certifies that a copy of the foregoing instrument was served upon the parties listed above. Personally _________________ or by U.S. Postal Service ___________________. ______________________________ (Signature) PAMELA J. MCGUIRE, CLERK OF THE CIRCUIT COURT OF WILL COUNTY Form 16 C Revised (08/05) American LegalNet, Inc. www.FormsWorkFlow.com