Lapsed Appropriation Form {CC-88}

Illinois Court of Claims Office of the Secretary of State 630 S. College St., Springfield, IL 62756 (Complete four copies) Lapsed Appropriation Form IN THE COURT OF CLAIMS, STATE OF ILLINOIS ) ) ) ) ) ) ) ) Claimant vs. Respondent, STATE OF ILLINOIS Claimant seeks from Respondent payment in the sum of $ ________________ for ______________________________ (Services or Materials) rendered as stated on the attached statement, and made a part thereof as Exhibit "A." Claimant requests payment of the sum of $ ________________ , and has made demand for same from ______________________________ of the State of Illinois, (Department, Board, Commission) and such demand was refused on the grounds that funds appropriated for the ______________________________________ (Services or Materials) for such payments have lapsed. Claimant further states that no assignment of said claim, or any interest therein, has been made to any person, and that Claimant is justly entitled to payment of the same from respondent after allowing all just credits. Claimant further states that the Claimant's Federal Employer Identification Number (F.E.I.N.) is: __________________ , or that his/her Social Security Number is: ____________________________ . _________________________________________ (Claimant's Signature) ________________________________________________ Claimant ________________________________________________ Claimant's Attorney ________________________________________________ Street Address ________________________________________________ OR Street Address ________________________________________________ City State ________________________________________________ City State ________________________________________________ ZIP County ________________________________________________ ZIP County ________________________________________________ Telephone Number ________________________________________________ Telephone Number The state agency is requesting disclosure of information that is necessary to accomplish the statutory purpose as outlined under 705 ILCS 505/1 et. seq. Disclosure of this information is REQUIRED. Failure to provide any information will result in this form not being process. Printed by authority of the State of Illinois - Sept 2016 - 1 - CC-88.2 American LegalNet, Inc. www.FormsWorkFlow.com Procedures for Filing Lapsed Claims 1. Collate the original complaint form, along with any itemized bills, invoices or other material that substantiate your claim. Make three additional copies of the complaint form and attach the supporting documentation to each one of the complaint forms (the original and three copies of each document) and mail to the Illinois Court of Claims. 2. Be sure to include Claimant's Social Security number/FEIN. 3. Be sure the application is filled out completely. American LegalNet, Inc. www.FormsWorkFlow.com