This form is approved by the Illinois Supreme Court and is required to be accepted in all Illinois Circuit Courts. AR - A 1403.3 Page 1 of 4 ( 0 1 /1 8 ) STATE OF ILLINOIS , For Court Use Only CIRCUIT COURT COUNTY Plaintiff / Petitioner ( First, middle, last name or Company ) v. 000(000Q000W000H000U000003 000\000R000X000U000003 000Q000D000P000H000003 000D000V000003 000W000K000H000003000'000H000I000H000Q000G000D000Q000W000022000003 0005000H000V000S000R000Q000G000H000Q000W 000021 000003 000(000Q000W000H000U000003000W000K000H000003000&000D000V000H0000030001000X000P000E000H000U000003000J000L000Y000H000Q000003000E000\000003000W000K000H000003000&000L000U000F000X000L000W000003000&000O000H000U000N000021000003 Defendant / Respondent ( First, middle, last name ) Case Number 000,000Q000003 1. My name is : First Middle Last 000,000Q000003 and I am the Defendant /Respondent . 2. My Answer/Response to Complaint/Petition is: Paragraph Number Subparagraph Letter (if applicable) Admit 000F Deny 000F Do Not Know 000F Admit 000F Deny 000F Do Not Know 000F Admit 000F Deny 000F Do Not Know 000F Admit 000F Deny 000F Do Not Know 000F Admit 000F Deny 000F Do Not Know 000F Admit 000F Deny 000F Do Not Know 000F Admit 000F Deny 000F Do Not Know 000F Admit 000F Deny 000F Do Not Know 000F Admit 000F Deny 000F Do Not Know Additional Paragraphs for Answer/Response to Complaint/Petition Admit Deny Do Not Know I have listed additional statements on the Additional Paragraphs for Answer /Response to Complaint/Petition form. If the Complaint/Petition is verified by oath, then I certify that my answers above are true and correct . I understand that making a false statement on this form is 000032000026000030000003000,000/000&0006000003000030000022000025000020000031000023000030000013000D000f 000003000U000H000T000X000L000U000H000V000003000W000K000D000W000003000L000I000003000W000K000H000003000&000R000P000S000O000D000L000Q000W0000220003000H000W000L000W000L000R000Q000003000L000V000003000Y000H000U000L000I000L000H000G000003000E000\000003000R000D000W000K000003000W000K000D000W000003000W000K000H000003Answer/Response to Complaint/Petition perjury and has penalties provided by law under 735 ILCS 5/1 - 109 . Enter the Case Number given by the Circuit Clerk: AR - A 1403.3 Page 2 of 4 ( 0 1 /1 8 ) Where I answer 223Do Not Know224 to paragraphs in section 2, above, I certify that I do not have enough information to admit or deny the statements in these paragraphs. I understand that making a false statement on this form is perjury and has penalties provided by law under 735 ILCS 5/1 - 109 . /s/ 000,000/0000030006000X000S000U000H000P000H000003000&000R000X000U000W000003 0005000X000O000H000003000024000026000032 000003000U000H000T000X000L000U000H000V000003000W000K000H000003Answer/Response to Complaint/Petition Your Signature Street Address Your Name City, State, ZIP 000,000I000003000\000R000X000003000D000U000H000003000F000R000P000S000O000H000W000L000Q000J000003000W000K000L000V000003000I000R000U000P000003000R000Q000003000D000003000F000R000P000S000X000W000H000U000017000003000V000L000J000Q000003000\000R000X000U000003000Q000D000P000H000003000E000\000003000W000\000S000L000Q000J000003000L000W000021000003000003000,000I000003000\000R000X000003000D000U000H000003000F000R000P000S000O000H000W000L000Q000J000003000L000W000003000E000\000003000K000D000Q000G000017000003000V000L000J000Q000003000D000Q000G000003000S000U000L000Q000W000003000\000R000X000U000003000Q000D000P000H000021000003000003 Telephone I agree to receive court documents at this email address during my entire case. Email PROOF OF DELIVERY 1. I sent this document: a. To: Name: 000,000Q000003 First Middle Last Address: Street , Apt # City State ZIP Email address: b. By: Personal hand delivery 000F Regular, First - Class Mail, put into the U.S. Mail with postage paid at: Address of Post Office or Mailbox 000F Third - party commercial carrier, with delivery paid for at: Name (for example, FedEx or UPS ) and office address 000F The court's electronic filing manager (EFM) or an approved electronic filing service provider (EFSP) 000F Email (not through an EFM or EFSP) 000F Mail from a prison or jail at: Name of prison or jail Enter the Case Number given by the Circuit Clerk: AR - A 1403.3 Page 3 of 4 ( 0 1 /1 8 ) c. On: Date At: a.m. p.m. Time 000,000Q000003 2. I sent this document: a. To: Name: First Middle Last Address: Street , Apt # City State ZIP Email address: b. By: Personal hand delivery 000F 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 3. I sent this document: a. To: Name: First Middle Last Address: Street , Apt # City State ZIP Email address: b. By: Personal hand delivery 000F Regular, First - Class Mail, put into the U.S. Mail with postage paid at: Address of Post Office or Mailbox 000F Third - party commercial carrier, with delivery paid for at: Name (for example, FedEx or UPS ) and office address 000F The court's electronic filing manager (EFM) or an approved electronic filing service provider (EFSP) 000F Email (not through an EFM or EFSP) 000F Mail from a prison or jail at: Name of prison or jail Enter the Case Number given by the Circuit Clerk: AR - A 1403.3 Page 4 of 4 ( 0 1 /1 8 ) c. On: Additional Proof of Delivery Date At: a.m. p.m. Time I have completed an Additional Proof of Delivery form. I certify that everything in the Proof of Service is true and correct. I understand that making a false statement on this form is perjury and has penalties provided by law under 735 ILCS 5/1 - 109 . /s/ Your Signature Street Address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rint Your Name City, State, ZIP Telephone