IN THE CIRCUIT COURT OF THE 17 TH JUDICIAL CIRCUIT WINNEBAGO COUNTY, ILLINOIS In the matter of: ) ) P ) ) Minor(s). of birth: Visitation with family (if any): Other comments: T his report may be e filed prior to the assigned court date . If you are unable to efile , you may return this report with your Certification for Exemption from eFiling form to W. State Street, Rockford, IL 61101. If the report is timely filed, your appearance will be excused and you will receive notice of the next status date. I hereby swear and/or affirm under penalty of perjury as provided by Section 1 - 109 of the Illinois Code of Civil Procedure that the foregoing statement is true and correct. Date: Guardian (sign): Address: Phon e: Email: FILE STAMP CC 117 V2 American LegalNet, Inc. www.FormsWorkFlow.com