This form is approved by the Illinois Supreme Court and is required to be accepted in all Illinois Circuit Courts. STATE OF ILLINOIS , CIRCUIT COURT COUNTY ADDITIONAL PROOF OF DELIVERY For Court Use Only I nstructions Plaintiff (Name of Bank or Mortgage Company) Directly above, enter county where the case is filed. Enter the name of the Plaintiff/ Petitioner . v. Defendants Case Number Enter the name of the Defendant/ Respondent . Enter the Case Number given by the Circuit Clerk. In 1a, enter the name, mailing address, and email address of the party or lawyer to whom you sent the document. In 1b, check the box to show how you sent the document, and fill in any other information required on the blank lines. 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. 1.003 I sent this document: a.003 To:002 Name:002 First003 Middle Last Address: Street , Apt #003 City State ZIP Email address: b.003 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.003 On: Date At: a.m. p.m. Time 2.003 I sent this document: a.003 To:002 Name:002 First003 Middle Last Address: Street , Apt #003 City State ZIP Email address: b.003 By: Personal hand delivery Regular, First - Class Mail, put into the U.S. Mail with postage paid at: In c, fill in the date and time that you sent the document. In 2, if you sent the document to more than 1 party or lawyer, fill in a, b, and c. Otherwise leave 2 blank. Address of Post Office or Mailbox Page 1 of 2003 (0/18) American LegalNet, Inc. www.FormsWorkFlow.com Enter the Case Number given by the Circuit Clerk: 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 3, if you sent the document to more than 2 parties or lawyers, fill in a, b, and c. Otherwise leave 3 blank. 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. 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. Name of prison or jail c.003 On: Date At: a.m. p.m. Time 3.003 I sent this document: a.003 To:002 Name:002 First003 Middle Last Address: Street , Apt #003 City State ZIP Email address: b.003 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 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 Print Your Name City, State, ZIP Telephone Page 2 of 2003 (0/18) American LegalNet, Inc. www.FormsWorkFlow.com