Form 171-234C "Joint Petition to Establish Parent and Child Relationship" - Lake County, Illinois

What Is Form 171-234C?

This is a legal form that was released by the Circuit Court Clerk’s Office - Lake County, Illinois - a government authority operating within Illinois. The form may be used strictly within Lake County. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on December 1, 2017;
  • The latest edition provided by the Circuit Court Clerk’s Office - Lake County, Illinois;
  • 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 171-234C by clicking the link below or browse more documents and templates provided by the Circuit Court Clerk’s Office - Lake County, Illinois.

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Download Form 171-234C "Joint Petition to Establish Parent and Child Relationship" - Lake County, Illinois

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IN THE CIRCUIT COURT OF THE NINETEENTH JUDICIAL CIRCUIT
LAKE COUNTY, ILLINOIS
IN RE THE
MARRIAGE
PARENTAGE
)
SUPPORT
ALLOCATION OF PARENTAL )
CIVIL UNION
RESPONSIBILITIES
)
)
)
_______________________________________________
)
)
vs.
)
)
Gen No. ________________________
)
______________________________________________
)
)
JOINT PETITION TO ESTABLISH PARENT AND CHILD RELATIONSHIP
Now come Petitioners, __________________________ and ____________________________ who jointly state:
(mother’s name)
(father’s name)
This action is brought pursuant to the Illinois Parentage Act of 2015, 750 ILCS 46/101 et seq.
1. The minor child(ren) was/were born to the Petitioners:
Child(ren)'s Name
Location Born
Birth Date
Child(ren) Currently Lives
2. The mother of the minor child(ren) is ___________________________________________________, who resides at
(mother’s name)
____________________________________________________________________________________________.
(mother’s current address)
3. The father of the minor child(ren) is ____________________________________________________, who resides at
(father’s name)
_____________________________________________________________________________________________ .
(father’s current address)
4. WHEREFORE, Petitioners pray that the Court determine: _______________________________ to be the legal and
(father’s name)
natural father of the minor child(ren), and hereby enter an order establishing (check all that apply):
the existence of a Parent and Child Relationship
allocation of parental responsibilities
retroactive child support
pre-natal and delivery costs
reimbursement of grants received
parenting time
health insurance
that the child(ren)’s name(s) be changed
child support
responsibility for medical costs not covered by insurance
Page 1 of 2
171-234c (Rev 12/17)
IN THE CIRCUIT COURT OF THE NINETEENTH JUDICIAL CIRCUIT
LAKE COUNTY, ILLINOIS
IN RE THE
MARRIAGE
PARENTAGE
)
SUPPORT
ALLOCATION OF PARENTAL )
CIVIL UNION
RESPONSIBILITIES
)
)
)
_______________________________________________
)
)
vs.
)
)
Gen No. ________________________
)
______________________________________________
)
)
JOINT PETITION TO ESTABLISH PARENT AND CHILD RELATIONSHIP
Now come Petitioners, __________________________ and ____________________________ who jointly state:
(mother’s name)
(father’s name)
This action is brought pursuant to the Illinois Parentage Act of 2015, 750 ILCS 46/101 et seq.
1. The minor child(ren) was/were born to the Petitioners:
Child(ren)'s Name
Location Born
Birth Date
Child(ren) Currently Lives
2. The mother of the minor child(ren) is ___________________________________________________, who resides at
(mother’s name)
____________________________________________________________________________________________.
(mother’s current address)
3. The father of the minor child(ren) is ____________________________________________________, who resides at
(father’s name)
_____________________________________________________________________________________________ .
(father’s current address)
4. WHEREFORE, Petitioners pray that the Court determine: _______________________________ to be the legal and
(father’s name)
natural father of the minor child(ren), and hereby enter an order establishing (check all that apply):
the existence of a Parent and Child Relationship
allocation of parental responsibilities
retroactive child support
pre-natal and delivery costs
reimbursement of grants received
parenting time
health insurance
that the child(ren)’s name(s) be changed
child support
responsibility for medical costs not covered by insurance
Page 1 of 2
171-234c (Rev 12/17)
_____________________________________________
_____________________________________________
Signature of Mother
Signature of Father
Verification
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 instrument are true and correct.
_____________________________________________
_____________________________________________
Signature of Mother
Signature of Father
Prepared by:
Name: ____________________________________ Pro Se
Address: __________________________________________
City: ______________________________ State: __________
Phone: ______________________Zip Code: _____________
ARDC #: __________________________________________
E-mail address: _____________________________________
Page 2 of 2
171-234c (Rev 12/17)
Page of 2