This form is approved by the Illinois Supreme Court and is required to be accepted in all Illinois Circuit Courts. PD - ASL 805.1 Page 1 of 2 (0 3 /1 8 ) STATE OF ILLINOIS , ADDITIONAL PROOF OF DELIVERY For Court Use Only CIRCUIT COURT COUNTY I nstructions Directly above, enter county where the case is filed. Enter the name of the Plaintiff/ Petitioner . Plaintiff / Petitioner ( First, middle, last name ) Enter the name of the Defendant/ Respondent . v. Enter the Case Number given by the Circuit Clerk. Case Number Defendant / Respondent ( First, middle, last name ) In 1a, enter the name, mailing address, and email address of the party or lawyer to whom you sent the document. 1. I sent this document: a. To: Name: First Middle Last Address: In 1b, check the box to show how you sent the document, and fill in any other information required on the blank lines. Street , Apt # City State ZIP Email address: b. By: Personal hand delivery Regular, First - Class Mail, put into the U.S. Mail with postage paid at: CAUTION: If the other party does not have a lawyer, you may send the document by email only if the other party has listed their email address on a court document. Address of Post Office or Mailbox Third - party commercial carrier, with delivery paid for at: Name (for example, FedEx or UPS ) and office address The court's electronic filing manager (EFM) or an approved electronic filing service provider (EFSP) Email (not through an EFM or EFSP) Mail from a prison or jail at: In c, fill in the date and time that you sent the document. Name of prison or jail c. On: Date At: a.m. p.m. Time In 2, if you sent the document to more than 1 party or lawyer, fill in a, b, and c. Otherwise leave 2 blank. 2. I sent this document: a. To: Name: First Middle Last Address: Street , Apt # City State ZIP Email address: b. By: Personal hand delivery Regular, First - Class Mail, put into the U.S. Mail with postage paid at: Address of Post Office or Mailbox American LegalNet, Inc. www.FormsWorkFlow.com Enter the Case Number given by the Circuit Clerk: PD - ASL 805.1 Page 2 of 2 ( 0 3 / 18 ) Third - party commercial carrier, with delivery paid for at: Name (for example, FedEx or UPS ) and office address The court's electronic filing manager (EFM) or an approved electronic filing service provider (EFSP) Email (not through an EFM or EFSP) Mail from a prison or jail at: Name of prison or jail c. On: Date At: a.m. p.m. Time In 3, if you sent the document to more than 2 parties or lawyers, fill in a, b, and c. Otherwise leave 3 blank. 3. I sent this document: a. To: Name: First Middle Last Address: Street , Apt # City State ZIP Email address: b. By: Personal hand delivery Regular, First - Class Mail, put into the U.S. Mail with postage paid at: Address of Post Office or Mailbox Third - party commercial carrier, with delivery paid for at: Name (for example, FedEx or UPS ) and office address The court's electronic filing manager (EFM) or an approved electronic filing service provider (EFSP) Email (not through an EFM or EFSP) Mail from a prison or jail at: Name of prison or jail c. On: Date At: a.m. p.m. Time 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. I certify that everything in the Additional Proof of Delivery is true and correct. I understand a false statement on this form is perjury and has pena lties provided by law under 735 ILCS 5/1 - 109 . /s/ Your Signature Street Address If you are completing this form on a computer, sign your name by typing it. If you are completing it by hand, sign and print your name. Print Your Name City, State, ZIP Telephone American LegalNet, Inc. www.FormsWorkFlow.com