IRIS Y. MARTINEZ
CLERK OF THE CIRCUIT COURT OF COOK COUNTY
CRIMINAL DEPARTMENT
50 W. Washington Street, Room 1006
Chicago, Illinois 60602
Tel: 312-603-5200/Fax: 312-603-5051
AFFIDAVIT FOR CHANGE OF ADDRESS FOR CANNABIS EXPUNGEMENT CASES
PLEASE FILL OUT THIS FORM COMPLETELY,
HAVE IT NOTARIZED
, THEN RETURN IT TO OUR OFFICE AT THE
ADDRESS INDICATED ABOVE OR VIA EMAIL* OR FAX.** THIS INFORMATION IS NEEDED TO PROMPTLY AND
PROPERLY NOTIFY YOU OF THE EXPUNGEMENT STATUS OF YOUR CASE(S).
THIS FORM WILL BE RETURNED IF IT IS NOT COMPLETED IN FULL AND NOTARIZED
I, _______________________________________________, ON OATH STATE THAT I AM THE PARTY WHOSE NAME
(PLEASE PRINT YOUR NAME) APPEARS ON THE FOLLOWING CANNABIS CASE OR CASES:
A. CASE NUMBER(S): ____________________________________________________________________________
B. I WOULD LIKE TO HAVE THE EXPUNGEMENT NOTIFICATION REGARDING MY CASE MAILED TO THE
FOLLOWING ADDRESS:
____________________________________________________________________________________________________
(ADDRESS) (APT#) (CITY) (STATE) (ZIP CODE)
I WILL BE MOVING TO THIS ADDRESS, OR THIS ADDRESS TAKES EFFECT ON, OR IS ALREADY EFFECTIVE ON:
____/____/______
BY SIGNING THIS AFFIDAVIT, I AUTHORIZE YOU TO SEND ME MY NOTIFICATION OF THE EXPUNGEMENT
STATUS OF MY CASE BY EMAIL TO: ______________________________________@ __________________._________
CELL PHONE NO: ____________________________ WORK PHONE NO: ____________________________
_____________________________________________ _________/________/___________
SIGNATURE DATE SIGNED
NOTARY: PLEASE PUT YOUR SEAL IN THIS SPACE
SUBSCRIBED AND SWORN TO BEFORE ME THIS:
_______DAY OF____________________, ____________
MY COMMISSION EXPIRES_____/_____/__________
________________________________________________
NOTARY PUBLIC SIGNATURE
IRIS Y. MARTINEZ, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS
*Email form to Cannabis@cookcountycourt.com; or
**Fax form to 312-603-5051; or
Mail form to Criminal Department, 50 West Washington, Room 1006, Chicago, IL 60602
