Non Standard Settlement Request Form PDF Details

Are you considering requesting a non-standard settlement? Monitoring the full range of negotiations and paperwork associated with such a process can be time-consuming and complex. By taking the right steps to understand your situation, options, and legal rights as well as familiarizing yourself with the necessary form documentation, you will set yourself up for success in successfully submitting a non-standard settlement request. In this blog post, we’ll provide an overview of what is involved in submitting a non standard settlement request form so that you have all of the information necessary to make an informed decision. Keep reading to get started today!

Form NameNon Standard Settlement Request Form
Form Length1 pages
Fillable fields0
Avg. time to fill out15 sec
Other namesillinois tollway form, illinois tollway hardship, ipass violation relief, settlement request

Form Preview Example

Non-Standard Settlement Request

Violator’s Name: ________________________________________________Phone #:_________________________

Address: __________________________________ City, State Zip: ______________________________________

License Plate(s): ____________________________ I-Pass: Yes or No (Circle) If yes, I-PASS Account #:

Hearing Date: ______________________________

Total number of persons in household: _________

Amount owed:

TOTAL: $ ___________ Amount Previously Paid $ ____________


Tolls $ ________ Pre-escalation fines: $ _________ Escalated Fines: $ __________

Reason for Violations/Hardship: ____________________________________________________________________



Bankruptcy: Yes or No (Circle) If YES, Case #: _______________.

Subject to Stay: Yes or No (Circle)

Violator’s Monthly Income: $ _____________ (Attach copy of pay record or Federal tax return)

Spouse/Family Member/Household Member Monthly Income $ _____________ (Attach copy of pay record)

Assets: Total: $ _________________



-Checking/Saving Accounts:

Total$____________________ (Attach copy)

-House: OWN or RENT (Circle)

Value $ _____________

Owe: $ ____________________________


Value $_____________

Owe $_____________________________

Liabilities: Total: $ _________________

-Monthly Expenses:


Housing: $___________

Car: $ __________ Electricity: $ __________ Gas $ __________

Other Expenses:

-Medical: $ __________. (Attach documentation of invoices if to be considered)

Violator’s Proposed Settlement: $ ____________

Source of Funds: (Savings, Credit Card or Borrowed from Third Party) _________________

Under penalties of law, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and belief, they are true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.

Signature: ______________________________________________________________ Date: _______________

Mail completed form with supporting documents to: Illinois Tollway, Customer Service Center, 2700 Ogden Ave., Downers Grove, IL 60515

To be completed by Tollway

Tollway’s Settlement Offer: $ ___________ Recommending Supervisor: ____________________________

Assistant Attorney General: _______________________ Approved: YES or NO (Circle) Amount: $_____________

How to Edit Non Standard Settlement Request Form Online for Free

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This PDF form will need specific data to be entered, so make sure to take some time to fill in what's required:

1. Begin completing your illinois tollway payment plan with a group of necessary blanks. Consider all of the information you need and make sure there is nothing overlooked!

Filling in section 1 in illinois tollway payment plan request

2. Once your current task is complete, take the next step – fill out all of these fields - CheckingSaving Accounts, Total Attach copy, House OWN or RENT Circle, Value, Owe, Car, Value, Owe, Liabilities Total, Monthly Expenses, Housing, Car Electricity Gas, Other Expenses, Medical Attach documentation of, and Violators Proposed Settlement with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

illinois tollway payment plan request conclusion process explained (portion 2)

Always be very attentive when filling in CheckingSaving Accounts and Car, since this is the part in which many people make mistakes.

3. The following part is related to To be completed by Tollway, Tollways Settlement Offer, and Assistant Attorney General - type in all of these blank fields.

Assistant Attorney General, Tollways Settlement Offer, and To be completed by Tollway of illinois tollway payment plan request

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