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Affidavit of Person Making Placement Clerk of the Circuit Court Form

Q: What is an Affidavit Of Person Making Placement Clerk Of The Circuit Court?

An Affidavit Of Person Making Placement Clerk Of The Circuit Court is a legal document that certifies the details related to the placement of an individual in a legal context. This affidavit is essential for ensuring compliance with court requirements and procedures. Using airSlate SignNow, you can effortlessly create and eSign this document to streamline your legal processes.

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Affidavit of person making placement clerk of the circuit court form

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Afﬁ davit of Person Making Placement (This form replaces CCCO-0000 A1) (Rev. 3/26/13) CCCO 0007 A IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS COUNTY DEPARTMENT, COUNTY DIVISION IN THE MATTER OF THE PETITION OF ________________________________________________________ and No. __________________________________ ________________________________________________________ TO ADOPT: ________________________________________________________ AFFIDAVIT OF PERSON MAKING PLACEMENT (2817) I, ___________________________________________ residing at ___________________________________________, __________________________________________________, a(n) _______________________________________ af ﬁ liated with or employed by _____________________________________________________________________________________ arranged the placement or transmitted information concerning the availability of the child to the petitioners or their agent. 1. State in speciﬁ c detail how you learned of the availability of the child? ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ 2. What is your relation to the adopting parents? (Friend, relative, patient, etc.) If none, how did your learn about them? ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ 3. How did you learn the adopting parents wanted a child? ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ 4. What expenses have you incurred or do you anticipate incurring? ITEMIZE AMOUNT ______________________________________________________________________ $ _______________________ ______________________________________________________________________ $ _______________________ ______________________________________________________________________ $ _______________________ (OVER) DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS (Rev.3/26/13) CCCO 0007 B 5. Name any person or organization, including yourself, who has or expects to receive any fees, gifts, donation or reimbursements, directly or indirectly, from adopting parent(s) or their agent, and the reason for the payment. ITEMIZE AMOUNT ______________________________________________________________________ $ _______________________ ______________________________________________________________________ $ _______________________ ______________________________________________________________________ $ _______________________ ______________________________________________________________________ $ _______________________ ______________________________________________________________________ $ _______________________ 6. Money gifts, donations or reimbursements paid or promised to be paid to the bioligical parents, whether by the adopting parents or any other persons: ITEMIZE AMOUNT ______________________________________________________________________ $ _______________________ ______________________________________________________________________ $ _______________________ ______________________________________________________________________ $ _______________________ ______________________________________________________________________ $ _______________________ ______________________________________________________________________ $ _______________________ CERTIFICATIONS Under penalties as provided by law pursuant to Section 1-109 of the Code of Civil Procedure, the undersigned certify that the statements set forth in this Afﬁ davit are true and correct. Dated: ___________________________, _________ (Signed) ______________________________________________ CERTIFICATION OF ATTORNEY OF RECORD Under penalties as provided by law pursuant to Section 1-109 of the code of Civil Procedure, the undersigned certiﬁ es that s/he has read and reviewed the AFFIDAVIT OF PERSON MAKING PLACEMENT, and that the contents thereof are true and correct to the best of his/her knowledge, information and belief. DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS (Signed) _______________________________________ Atty. No: ____________________________________ Name: ______________________________________ Atty. for: ____________________________________ Address: ____________________________________City/State/Zip: _______________________________ Telephone: __________________________________ Email address: _______________________________

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