TABLE OF CONTENTS

1. Caption
2. Parties
3. Jurisdiction and Venue
4. Factual Allegations
5. Count I - Dram Shop Liability (235 ILCS 5/6-21)
6. Count II - Loss of Means of Support (235 ILCS 5/6-21)
7. Damages
8. Jury Demand
9. Prayer for Relief
10. Verification
11. State-Specific Notes
12. Sources and References

CAPTION

IN THE CIRCUIT COURT OF THE [________________________________] JUDICIAL CIRCUIT
[________________________________] COUNTY, ILLINOIS

[________________________________],
Plaintiff,

v.

[________________________________] (d/b/a [________________________________]),
Defendant(s).

Case No.: [________________________________]

PARTIES

1. Plaintiff [________________________________] is a resident of [________________________________] County, Illinois, and is the person injured in person, property, or means of support as a result of the acts described herein.

2. Defendant [________________________________] (hereinafter "Licensee Defendant") is a person licensed to sell alcoholic liquor in Illinois, operating as [________________________________], located at [________________________________], Illinois.

3. [________________________________] (hereinafter "Intoxicated Person") was at all relevant times a person whose intoxication was caused by the sale or gift of alcoholic liquor by the Licensee Defendant.

JURISDICTION AND VENUE

4. This Court has jurisdiction over this action pursuant to 735 ILCS 5/2-209.

5. Venue is proper in this County pursuant to 735 ILCS 5/2-101 because the acts giving rise to this claim occurred in [________________________________] County, Illinois.

FACTUAL ALLEGATIONS

6. On or about [__/__/____], the Intoxicated Person was present at the Licensee Defendant's premises at [________________________________].

7. The Licensee Defendant, through its agents, employees, or servants, sold or gave alcoholic liquor to the Intoxicated Person.

8. The sale or gift of alcoholic liquor by the Licensee Defendant caused the intoxication of the Intoxicated Person, in whole or in part.

9. Following the sale or gift of alcoholic liquor, and while intoxicated, the Intoxicated Person [________________________________] [describe injurious conduct].

10. As a direct and proximate result, Plaintiff sustained injury to [his/her] person, property, or means of support, including but not limited to [________________________________].

COUNT I - DRAM SHOP LIABILITY (235 ILCS 5/6-21)

11. Plaintiff re-alleges and incorporates paragraphs 1 through 10.

12. Pursuant to 235 ILCS 5/6-21, every person who is injured in person or property by any intoxicated person has a right of action against any person who, by selling or giving alcoholic liquor, caused the intoxication of such person.

13. The Licensee Defendant sold or gave alcoholic liquor to the Intoxicated Person.

14. The Licensee Defendant's sale or gift of alcoholic liquor caused, in whole or in part, the intoxication of the Intoxicated Person.

15. The intoxication of the Intoxicated Person was a proximate cause of the injuries sustained by Plaintiff in the State of Illinois.

16. As a result, the Licensee Defendant is liable to Plaintiff for damages within the statutory limits.

COUNT II - LOSS OF MEANS OF SUPPORT (235 ILCS 5/6-21)

17. Plaintiff re-alleges and incorporates paragraphs 1 through 10.

18. Plaintiff is the [________________________________] [spouse/child/parent] of [________________________________], who was injured or killed as a result of the Intoxicated Person's conduct.

19. As a result of the injuries to or death of [________________________________], Plaintiff has been deprived of means of support.

20. Pursuant to 235 ILCS 5/6-21, Plaintiff is entitled to recover damages for loss of means of support and society.

DAMAGES

21. As a direct and proximate result of the Defendant's conduct, Plaintiff has suffered:

Count I - Personal Injury/Property Damage:
☐ Past and future medical expenses: $[________________________________]
☐ Past and future lost wages and earning capacity: $[________________________________]
☐ Pain and suffering: $[________________________________]
☐ Mental anguish and emotional distress: $[________________________________]
☐ Loss of enjoyment of life: $[________________________________]
☐ Property damage: $[________________________________]

Count II - Loss of Support (if applicable):
☐ Loss of means of support: $[________________________________]
☐ Loss of society: $[________________________________]

JURY DEMAND

22. Plaintiff hereby demands a trial by jury on all issues so triable.

PRAYER FOR RELIEF

WHEREFORE, Plaintiff respectfully requests that this Court:

a. Enter judgment against Defendant(s) and in favor of Plaintiff;
b. Award compensatory damages up to the statutory maximum as currently adjusted;
c. Award pre-judgment and post-judgment interest;
d. Award costs of this action;
e. Grant such other and further relief as this Court deems just and proper.

VERIFICATION

STATE OF ILLINOIS
COUNTY OF [________________________________]

I, [________________________________], under penalties as provided by law pursuant to 735 ILCS 5/1-109, certify that the statements set forth in this instrument are true and correct, except as to matters therein stated to be on information and belief, and as to such matters, I certify as aforesaid that I believe them to be true.

_____________________________________________
[________________________________], Plaintiff
Date: [__/__/____]

Respectfully submitted,

_____________________________________________
[________________________________]
Attorney for Plaintiff
[________________________________]
[________________________________]
ARDC No.: [________________________________]
Telephone: [________________________________]
Email: [________________________________]

STATE-SPECIFIC NOTES

• Statute: 235 ILCS 5/6-21 (Illinois Dram Shop Act) -- one of the most established in the U.S.
• Broad Standard: The statute requires only that the licensee's sale or gift of alcohol "caused the intoxication" that led to injury. Unlike many states, it does NOT specifically require proof of visible intoxication at the time of service or knowledge of minor status.
• SHORTENED STATUTE OF LIMITATIONS: One year from the date the cause of action accrued -- significantly shorter than the general two-year personal injury period.
• STATUTORY DAMAGES CAP: Adjusted annually by the Illinois Comptroller (CPI-U). Verify current caps before filing.
• Loss of Support Claim: Separate statutory claim for persons deprived of means of support with its own damages cap.
• Comparative Fault: 735 ILCS 5/2-1116 applies; plaintiff barred if more than 50% at fault.
• Distributor/Brewer Exemption: Distributors or brewers who only furnished cooling/dispensing equipment are exempt.
• Social Host Provision: Limited liability for adults (21+) who pay for hotel/motel rooms knowing under-21 persons will consume alcohol there.
• Illinois Verification: Uses 735 ILCS 5/1-109 certification rather than traditional notarized verification.

SOURCES AND REFERENCES

• 235 ILCS 5/6-21 (Illinois Dram Shop Act)
• 735 ILCS 5/2-1116 (Comparative Fault)
• Illinois Comptroller's Office (annual damages cap adjustments)