IN THE CIRCUIT COURT OF THE TWELFTH JUDICIAL CIRCUIT WILL COUNTY, ILLINOIS _______________________________________ Plaintiff vs CASE NO: ____________________________________ CH-Residential Mortgage Foreclosure _______________________________________ Defendant VERIFIED STATEMENT (Pursuant to 735 ILCS 5/15-1504.1) The Plaintiff, __________________________________________________________________________, (Attorney or Law Firm) is not a depository institution and is filing the complaint on behalf of a mortgagee that, together with its affiliates, identify below that they have filed no and/or a sufficient number of residential mortgage foreclosure complaints so as to be exempt and/or included in the first, second, or third tier foreclosure category states as follows: No mortgage foreclosure complaints on residential real estate located in Illinois during the calendar year immediately preceding the date of the filing of the subject foreclosure complaint to certify their eligibility for the exemption from the additional fee set forth in the above statute. Has filed 175 or more foreclosure complaints on residential real estate located in Illinois during the calendar year immediately preceding the date of the filing of the subject foreclosure complaint to certify their classification as a "First tier foreclosure filing category" and have submitted the additional fees set forth in the above statute. Has filed at least 50, but not more than 174 foreclosure complaints on residential real estate located in Illinois during the calendar year immediately preceding the date of the filing of the subject foreclosure complaint to certify their classification as a "Second tier foreclosure filing category" and have submitted the additional fees set forth in the above statute. Has filed no more than 49 foreclosure complaints on residential real estate located in Illinois during the calendar year immediately preceding the date of the filing of the subject foreclosure complaint to certify their classification as a "Third tier foreclosure filing category" and have submitted the additional fees set forth in the above statute. __________________________________________ (Signature) CERTIFICATION Under penalties of perjury as provided by law pursuant to Section 1-109 of the Code of Civil Procedure, the undersigned certifies the statements set forth in this instrument are true and correct, except as to matters therein stated to be on information and belief, and as to such matters, the undersigned certifies as aforesaid that he/she verily believes the same to be true. __________________________________________ (Signature) Name _____________________________________ ARDC # ___________________________________ Firm Name _________________________________ Attorney for ________________________________ Address ___________________________________ City & Zip _________________________________ Telephone _________________________________ ANDREA LYNN CHASTEEN, CLERK OF THE CIRCUIT COURT OF WILL COUNTY Orig. ­ Court Copy ­ Plaintiff American LegalNet, Inc. www.FormsWorkFlow.com 150 (12/16)