In the event it shall be determined that all the judges of the circuit are disqualified or are unable to act in such action, the presiding judge of the circuit shall make and file in the office of the clerk of courts of the court involved an order to that effect. The clerk with whom such order is filed shall forthwith forward to the clerk of the Supreme Court the following:

1. (1) A certified copy of the affidavit for change of judge;
2. (2) A certified copy of the order of the presiding judge determining that all the judges of his circuit are disqualified or unable to act; and
3. (3) A signed statement in duplicate showing the title of the action, the name and address of each attorney of record therein, the date of filing of such affidavit, the general nature of the action and the status thereof.

Source: Supreme Court Rule No. 75-5, § 15.