This form is approved by the Illinois Supreme Court and is required to be accepted in all Illinois Appellate Courts. Instruction s THIS APPEAL INVOLVES A MATTER SUBJECT TO EXPEDITED DISPOSITION UNDER RULE 311(a). Appellate Case No.: IN THE APPELLATE COURT OF ILLINOIS District Check the box to the right if your case involves custody, visitation, or removal of a child. Enter the Appellate Court case number. Just below "In the Appellate Court of Illinois," enter the number of the appellate district that will hear the appeal. In r e Appeal from the Circuit Court of County If the case name in the trial court began with 223In re224 (for example, 223In re Marriage of Jones224), enter that Trial Court Case No.: name. Below that, enter the names of the Plaintiff/Petitioner (First, middle, last name s ) parties in the trial court, and check the correct Appellant Appellee Honorable boxes to show which party filed the appeal (223appellant224) and which party is responding to v. J udge, Presiding the appeal (223appellee224). Defendant/Respondent (First, middle, last name s ) Appellant Appellee To the far right, enter the trial court county, trial court case number, and trial judge's name. In 1, check the reasons you are asking to file by mail or in person. You should check all that apply. You are exempt from e-filing and you do not need to file this Certification if: you are in jail orprison;you are filing awill;you are filing intoa juvenile case;ORyour disabilityprevents you frome-filing.CERTIFICATION FOR EXEMPTION FROM E-FILING 1. I am not able to e - file documents in this case for the following reasons (c heck all that apply) : I am representing myself and do not have the Internet or a computer in my home . M y only access is through a public terminal at a courthouse, library, or other location. This poses a financial or other hardship. I am representing myself and have trouble reading, writing, or speaking in English. I am filing a document in a sensitive case, such as a petition for an order of protection or a civil no contact/stalking order. 2. Illinois Supreme Court Rule 9(c)(5) allows for an exemption from e - filing for good cause. For the above reasons, I need a good cause exemption from e - filing for my entire case or until I am able to e - file. EW - C 3401.2 Page 1 of 2003 (01/1) American LegalNet, Inc. www.FormsWorkFlow.com Enter the Case Number given by the Circuit Clerk: I certif y that everything in the Certification for Exemption from E - filing is true and correct. I002 understand that making a false statement on this form is perjury and has penalties provided002 by law under 735 ILCS 5/1 - 109 .002 Under the Code of Civil Procedure, 735 ILCS 5/1-109, making a statement on this form that you know to be false is perjury, a Class 3 Felony. After you finish this form, sign and print your name. Enter your complete address and telephone number. Your Signature Street Address Print Your Name City, State, ZIP Telephone EW - C 3401.2 Page 2 of 2 (01/1) American LegalNet, Inc. www.FormsWorkFlow.com