Form BRA-A4404.1 "Agreed Statement of Facts" - Illinois

What Is Form BRA-A4404.1?

This is a legal form that was released by the Illinois Appellate Court - a government authority operating within Illinois. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on May 1, 2019;
  • The latest edition provided by the Illinois Appellate Court;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form BRA-A4404.1 by clicking the link below or browse more documents and templates provided by the Illinois Appellate Court.

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Download Form BRA-A4404.1 "Agreed Statement of Facts" - Illinois

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This form is approved by the Illinois Supreme Court and is required to be accepted in all Illinois Appellate Courts.
Instructions
THIS APPEAL INVOLVES A MATTER SUBJECT TO EXPEDITED DISPOSITION UNDER
RULE 311(a).
Check the box to the
right if your case
involves parental
responsibility or
Appellate Case No.:
parenting time
(custody/visitation
rights) or relocation of
a child.
Enter the appellate
IN THE APPELLATE COURT OF
court case number.
ILLINOIS
Just below "In the
Appellate Court of
District
Illinois," enter the
number of the
appellate district
Appeal from the Circuit Court
where the appeal was
filed.
In re
of
County
If the case name in the
trial court began with
Trial Court Case No.:
"In re" (for example,
"In re Marriage of
Jones"), enter that
Plaintiff/Petitioner (First, middle, last names)
phrase. If the case
name did not begin
Appellant
Appellee
Honorable
with "In re," enter the
names of the parties as
they appeared in the
trial court documents.
v.
Judge, Presiding
Below each party
name check either
Appellant if the party
filed the appeal or
Defendant/Respondent (First, middle, last names)
Appellee if the party
is responding to the
appeal.
To the far right, enter
Appellant
Appellee
the trial court county,
trial court case number,
and trial judge's name.
AGREED STATEMENT OF FACTS
In 1, enter all of the
1. Dates of Hearing or Trial:
hearing or trial dates
that you will describe
a.
Date:
Time:
a.m.
p.m.
Judge:
in this Bystander’s
Report. You also must
b.
Date:
Time:
a.m.
p.m.
Judge:
enter the time each
hearing or trial started
and the name of the
c.
Date:
Time:
a.m.
p.m.
Judge:
judge.
d.
Date:
Time:
a.m.
p.m.
Judge:
e.
Date:
Time:
a.m.
p.m.
Judge:
f.
Date:
Time:
a.m.
p.m.
Judge:
g.
Date:
Time:
a.m.
p.m.
Judge:
BRA- A 4404.1
Page 1 of 5
(05/19)
This form is approved by the Illinois Supreme Court and is required to be accepted in all Illinois Appellate Courts.
Instructions
THIS APPEAL INVOLVES A MATTER SUBJECT TO EXPEDITED DISPOSITION UNDER
RULE 311(a).
Check the box to the
right if your case
involves parental
responsibility or
Appellate Case No.:
parenting time
(custody/visitation
rights) or relocation of
a child.
Enter the appellate
IN THE APPELLATE COURT OF
court case number.
ILLINOIS
Just below "In the
Appellate Court of
District
Illinois," enter the
number of the
appellate district
Appeal from the Circuit Court
where the appeal was
filed.
In re
of
County
If the case name in the
trial court began with
Trial Court Case No.:
"In re" (for example,
"In re Marriage of
Jones"), enter that
Plaintiff/Petitioner (First, middle, last names)
phrase. If the case
name did not begin
Appellant
Appellee
Honorable
with "In re," enter the
names of the parties as
they appeared in the
trial court documents.
v.
Judge, Presiding
Below each party
name check either
Appellant if the party
filed the appeal or
Defendant/Respondent (First, middle, last names)
Appellee if the party
is responding to the
appeal.
To the far right, enter
Appellant
Appellee
the trial court county,
trial court case number,
and trial judge's name.
AGREED STATEMENT OF FACTS
In 1, enter all of the
1. Dates of Hearing or Trial:
hearing or trial dates
that you will describe
a.
Date:
Time:
a.m.
p.m.
Judge:
in this Bystander’s
Report. You also must
b.
Date:
Time:
a.m.
p.m.
Judge:
enter the time each
hearing or trial started
and the name of the
c.
Date:
Time:
a.m.
p.m.
Judge:
judge.
d.
Date:
Time:
a.m.
p.m.
Judge:
e.
Date:
Time:
a.m.
p.m.
Judge:
f.
Date:
Time:
a.m.
p.m.
Judge:
g.
Date:
Time:
a.m.
p.m.
Judge:
BRA- A 4404.1
Page 1 of 5
(05/19)
Enter the Case Number given by the Appellate Court Clerk:_________________________________
In 2, describe exactly
what the judge, the
2. This is what happened in my case, starting with the first hearing listed above and
parties, the witnesses,
and the lawyers said or
ending with the final ruling made by the judge. Specifically:
did in court during the
hearings or trial,
including any rulings
the judge made. Be
sure to include the date
of each hearing. Use as
much detail as you can.
It is best to describe
things in the order that
they happened.
BRA- A 4404.1
Page 2 of 5
(05/19)
Enter the Case Number given by the Appellate Court Clerk:_________________________________
If you need more room,
check the box and fill
out an Additional
Agreed Statement of
Facts Information
form. Insert it after this
I have completed an Additional Agreed Statement of Facts Information form.
page.
After you finish this
/s/
form, all parties and
Signature of Appellant or Appellant's Lawyer
Street Address
their lawyers must
sign and print their
names.
Name
City, State, ZIP
Enter the addresses
and telephone
numbers of everyone
signing this form.
Telephone
If you are completing
this form on a
Signature of Appellee or Appellee's Lawyer
Street Address
computer, sign your
name by typing it. If
you are completing it
by hand, sign by hand
Name
City, State, ZIP
and print your name.
Telephone
If need room for more
I have completed an Additional Signature form.
signatures, check the
box and fill out an
Additional Signature
form. Insert it after
this page.
BRA- A 4404.1
Page 3 of 5
(05/19)
Enter the Case Number given by the Appellate Court Clerk:_________________________________
PROOF OF SERVICE
(You must serve the other party and complete this section)
1.
I sent this document:
In 1a, enter the name,
mailing address, and
email address of the
a. To:
party or lawyer to
Name:
whom you sent the
First
Middle
Last
document.
Address:
Street, Apt #
City
State
ZIP
Email address:
 Personal hand delivery
In 1b, check the box to
b. By:
show how you sent the
 Regular, First-Class Mail, put into the U.S. Mail with postage paid at:
document, and fill in
any other information
Address of Post Office or Mailbox
required on the blank
lines.
 Third-party commercial carrier, with delivery paid for at:
CAUTION: If the
other party does not
Name (for example, FedEx or UPS) and office address
have a lawyer, you may
 The court's electronic filing manager (EFM) or an approved electronic filing
send the document by
service provider (EFSP)
email only if the other
party has listed their
 Email
(not through an EFM or EFSP)
email address on a
 Mail from a prison or jail at:
court document.
Name of prison or jail
In c, fill in the date and
c.
On:
time that you sent the
Date
document.
 a.m.
 p.m.
At:
Time
2.
I sent this document:
In 2, if you sent the
document to more than
1 party or lawyer, fill in
a. To:
a, b, and c. Otherwise
Name:
leave 2 blank.
First
Middle
Last
Address:
Street, Apt #
City
State
ZIP
Email address:
 Personal hand delivery
b. By:
 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
 a.m.
 p.m.
At:
Time
BRA- A 4404.1
Page 4 of 5
(05/19)
Enter the Case Number given by the Appellate Court Clerk:_________________________________
3. I sent this document:
In 3, if you sent the
document to more than
2 parties or lawyers, fill
a.
To:
in a, b, and c.
Name:
Otherwise leave 3
First
Middle
Last
blank.
Address:
Street, Apt #
City
State
ZIP
Email address:
 Personal hand delivery
By:
b.
 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
If you are serving more
than 3 parties or
 p.m.
At:
a.m.
lawyers, check the box
Time
and fill out an
Additional Proof of
I have completed an Additional Proof of Service form.
Service form. Insert it
Under the Code of
I certify that everything in the Proof of Service is true and correct. I understand that making
Civil Procedure,
735
a false statement on this form is perjury and has penalties provided by law
ILCS
5/1-109, making
under
735 ILCS
5/1-109.
a statement on this
form that you know to
be false is perjury, a
Class 3 Felony.
/s/
Your S ignature
If you are completing
this form on a
computer, sign your
name by typing it. If
Print Your Name
you are completing it
by hand, sign by hand
and print your name.
BRA- A 4404.1
Page 5 of 5
(05/19)
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