Section 500.10  Definitions

 

"Act" means the Vital Records Act.

 

"Adoption Act" means 750 ILCS 50.

 

"Affiant" means the person signing the correction form.

 

"Bona fide research" means research that uses scientific methods and analyses for the purpose of generating generalizable new knowledge and understanding, while abiding by all legal and ethical requirements and practices. 

 

"Bona fide researcher" means a person with the formal education, professional expertise and experience to conduct bona fide research.

 

"Certificate" means an officially registered Certificate of Live Birth, Delayed Record of Birth, Medical Death, Medical Examiner's/Coroner's Death, or Fetal Death (Stillbirth).

 

"Certified court order", "court order", "appropriate court order", and "court determination" means a written order entered by a court of competent jurisdiction that is certified by the clerk of the court and dated, and that includes the full information required by the State Registrar to amend, correct, replace, impound, open or create a vital record without reference to any other document.

 

"Civil union" or "Marriage" means a legal relationship between two persons with the same legal obligations, responsibilities, protections, and benefits. The term "marriage" in this Part is interpreted as a synonym for civil union. (Section 10 of the Illinois Religious Freedom Protection and Civil Union Act)

 

"Correction" means the correction or amendment of a certificate to reflect the correct information at items where incorrect information was originally entered; or the addition of correct information for items previously omitted from the certificate. "Correction" does not mean to enter on the certificate facts or information different from those which existed at the time of the event.

 

"Correction form" means the standard correction form "Affidavit and Certificate of Correction" prescribed by the State Registrar.

 

"Court of competent jurisdiction" means any Circuit Court in Illinois, any United States District Court, any equivalent court in any state or United States territory, any tribal court of any of the Indian Nations located within the United States, and any State or federal appellate level court in the United States. "Court of competent jurisdiction" does not include any religious court or any administrative body or tribunal without general State or federal trial jurisdiction.

 

"Custodian" means the State Registrar of Vital Records, local registrars or county clerks.

 

"Delayed birth registration" means the registration of any birth that was not registered within three days after the event and includes:

 

the registration of a birth that occurred more than three days, but less than one year prior to the application for registration;

 

the registration of a birth that occurred more than one year, but less than seven years prior to the application for registration; and

 

the registration of a birth that occurred more than seven years prior to the application for registration.

 

"Department" means the Illinois Department of Public Health or its designated agent.

 

"Director" means the Director of the Illinois Department of Public Health or the Director’s designee.

 

"District" means a specific geographic location in the State, for the purpose of registration of birth, death and fetal certificates.

 

"Final disposition" means the burial, cremation, or other disposition of a dead human body, fetus, or parts of a dead human body or fetus, including depositing in a vault or tomb, removal from the State, or use by a hospital or other institution for medical or scientific study in accordance with the Cadaver Act and Section 8 of the Uniform Anatomical Gift Act.

 

"Foundling" means a child found who was abandoned by a parent or parents whose identity is not known.

 

"Funeral director" means a person licensed by the State of Illinois to practice funeral directing, or a person acting under the direct supervision of an Illinois licensed funeral director as an employee or an associate of the funeral director.

 

"Gestational surrogacy" means the process by which a woman attempts to carry and give birth to a child created through in vitro fertilization using the gamete or gametes of at least one of the intended parents and to which the gestational surrogate has made no genetic contribution.  (Section 10 of the Gestational Surrogacy Act)

 

"Gestational surrogacy contract" means a written agreement regarding gestational surrogacy.  (Section 10 of the Gestational Surrogacy Act)

 

"Gestational surrogate" means a woman who agrees to engage in a gestational surrogacy.  (Section 10 of the Gestational Surrogacy Act)

 

"Intended parent" means a person or persons who enter into a gestational surrogacy contract with a gestational surrogate pursuant to which he or she will be the legal parent of the resulting child.  (Section 10 of the Gestational Surrogacy Act)  The intended parent or parents can be married, in a civil union or single.

 

"Legal representative" refers to:

 

A licensed attorney-at-law acting on behalf of a person or persons named on a birth certificate;

 

an agent authorized by written power of attorney;

 

a court-appointed personal representative;

 

an agent with written, notarized authorization from a person or persons named on a birth certificate for the purpose of obtaining a certified copy for that person; or

 

any other agent, approved by the State Registrar as a legal representative of the person to whom the birth certificate relates.

 

"Local registrar" refers to an individual who is appointed by the State Registrar, administers and enforces the provisions of the Vital Records Act, requires that certificates be completed and filed in accordance with the provisions of the Vital Records Act, and prepares files and retains, for a period of at least 10 years, an accurate copy of each record of live birth, death and fetal death.

 

"Major correction" includes, but is not limited to, any correction made more than one year after the date of the occurrence, or a correction made within one year after the date of the occurrence relating to these items (except as provided in Section 500.40(f)(3)(D)):

 

significant changes in the surname of the registered person;

 

on births, changes in the date or place of the occurrence;

 

the parent's or parents' age, if changed more than two years;

 

changes in the cause of death;

 

the identity of the parent or parents on the birth certificate;

 

changes in marital status;

 

the birth date or age of the decedent on a death certificate; or

 

other like circumstances.

 

Any other single item corrected within one year after the occurrence is considered a "minor correction".

 

"Minor correction" means any correction made within one year after the occurrence not meeting the criteria of a major correction.

 

"Personal services contract" means a contract between a unit of the State or local government body and an individual or a firm for the provision of services to the unit of the State or local government.

 

"Registration district" means a specific geographic location in the State, for the purpose of registration of birth, death and fetal certificates as described in 410 ILCS 535/6 of the Vital Records Act.

 

"State Registrar" means the State Registrar of Vital Records.

 

"Vital records" means records of births, deaths, fetal deaths, marriages, dissolution of marriages, and data related thereto.

 

(Source:  Amended at 46 Ill. Reg. 20036, effective November 30, 2022)

 

Section 500.15  Referenced Materials

 

The following Illinois statutes and administrative rules are referenced in this Part:

 

a)         Freedom of Information Act [5 ILCS 140]

 

b)         State Records Act [5 ILCS 160]

 

c)         Cadaver Act [410 ILCS 510]

 

d)         Vital Records Act [410 ILCS 535]

 

e)         Article 8, Part 21 of the Code of Civil Procedure [735 ILCS 5/Art. 8, Part 21]

 

f)         Illinois Parentage Act of 1984 [750 ILCS 45]

 

g)         Gestational Surrogacy Act [750 ILCS 47]

 

h)         Adoption Act [750 ILCS 50]

 

i)          Uniform Anatomical Gift Act [755 ILCS 50]

 

j)          Illinois Marriage and Dissolution of Marriage Act [750 ILCS 5]

 

k)         Illinois Religious Freedom Protection and Civil Union Act [750 ILCS 75]

 

l)          Juvenile Court Act of 1987 [705 ILCS 405]

 

m)        Local Health Protection Grant Code (77 Ill. Adm. Code 615)

 

n)         Access to Records of the Department of Public Health (2 Ill. Adm. Code 1127)

 

(Source:  Amended at 46 Ill. Reg. 20036, effective November 30, 2022)

 

Section 500.20  Access to Vital Records

 

a)         To protect the integrity of vital records, to insure their proper use, and to insure the efficient and proper administration of the vital records system, access to vital records, and indexes thereof, is limited to the custodian and his employees, and then only for administrative purposes. Nothing in this Part shall be construed as authorization to permit access to or inspection of the vital records by any person other than the custodians or their employees, nor as authorization to disclose information contained in these records, or copy, or permit to be copied, all or any part of these records, except as authorized by the Act or this Part, or the Adoption Act (Section 24(1) of the Act).

 

b)         The State Registrar of Vital Records, or his agent, and any municipal, county, multi-county health department, public health district, or regional health officer recognized by the Department may examine vital records for the purpose only of carrying out the public health programs and responsibilities under his jurisdiction (Section 24(2) of the Act). Vital records shared under this subsection may include parts of the Certificate of Live Birth, including the Birthing Parent's Medical and Health Information, when needed for the limited purpose of carrying out public health programs.  Only the minimum information necessary for the intended purpose shall be disclosed. A person or entity to whom vital records copies or data, including, but not limited to, medical and health information, is furnished or to whom access to records has been given shall not divulge any part of the information so as to disclose the identity of the person to whom the information or record relates.

 

c)         The State Registrar of Vital Records, may disclose, or authorize the disclosure of, data contained in the vital records when deemed essential for bona fide research purposes which are not for private gain (Section 24(3) of the Act).

 

d)         Federal, State, local and other public or private agencies may, upon request, be furnished copies or data for statistical purposes upon terms or conditions as may be prescribed by the Department. Copies of vital records or data will be shared when deemed by the Department to be in the public's interest, and not for the purpose of commercial solicitation or private gain.  Requests for data will be handled the same as bona fide research requests in accordance with Section 500.70.

 

e)         In accordance with Jane Doe II v. Lumpkin, it shall be the duty of the persons responsible for the completion of the Certificate of Live Birth to ensure that the information necessary to complete the form is collected, recorded, and maintained in a confidential manner.  This duty includes retaining, in a secure manner, only one copy of either the original birth record or the worksheet unless the hospital can demonstrate to the State Register that more than one copy is necessary for the maintenance of hospital records.  Under no circumstances shall the original certificate or worksheet be disclosed to anyone other than the birthing parent, hospital officials responsible for completing the form, the State Registrar, the local registrar in the case of a home birth, or hospital personnel directly involved in the birthing parent's care and then only for administrative or health care purposes.

 

f)         In accordance with Jane Doe II v. Lumpkin, hospital personnel responsible for the preparation of the Certificate of Live Birth are strictly prohibited from requesting any information or consent from the birthing parent or from presenting the worksheet and/or the original certificate to the birth parents for information, review, or signatures in the presence of anyone other than hospital personnel directly involved in the birthing parent's care.  The coparent's signature shall be affixed to the original worksheet in a manner that will not divulge the data contained in the section titled "Information for Medical and Health Use Only".

 

g)         In accordance with Jane Doe II v. Lumpkin, under no circumstances shall the section of the Certificate of Live Birth entitled "Information for Medical and Health Use Only" be disclosed to anyone, with the exception of the birthing parent, the State Registrar, the local registrar in the case of a home birth, and hospital personnel directly involved in the birthing parent's care, unless written informed consent has been given by the birthing parent.  This prohibition includes the coparent of the infant and all immediate and extended family members.  Consent shall be obtained from the birthing parent only when the birthing parent is alone or in the presence of hospital personnel directly involved in the birthing parent's care.

 

h)         In adoption cases, the original birth certificate shall not be subject to inspection until the adopted person has reached the age of 21 years.  The original birth certificate shall be made available as provided in Section 18.1b(e) of the Adoption Act [410 ILCS 535/17 (2a)].

 

i)          Certified copies of an official birth record will be provided to the person to whom the record relates (if the person is 18 years of age or older), or to the parents, to the legal guardians, and to the legal representative, of the person to whom the record relates, upon identification, proof of authority, and payment of the fee under Section 25 of the Act.

 

j)          Certified copies of an official death record will be provided to the administrator or executor of the decedent's estate.

 

k)         Nothing in this Part shall be construed to permit disclosure of information contained in the "Information for Medical and Health Use Only" section of the Certificate of Live Birth and the Certificate of Fetal Death unless specifically authorized by a court of competent jurisdiction;

 

l)          Nothing in this Part shall be construed to permit disclosure of information contained in the "Information for Statistical Purposes Only" section of the Certificate of Marriage or Certificate of Dissolution, Invalidity of Marriage, or Legal Separation unless specifically authorized by the State Registrar for statistical or research purposes or if authorized by a court of competent jurisdiction pursuant to 77 Ill. Adm. Code 500.70.

 

m)        All information submitted to the Adoption Registry is confidential and gathered by the State solely for the purpose of facilitating the exchange of updated medical data and contact information between adopted and surrendered persons and other registered parties.  Information exchanged through the Registry shall not be admissible as evidence nor discoverable in any action of any kind in any court or before any tribunal, board, agency, or commission and shall not be disclosed, except as authorized by this Part under the Adoption Act.  Disclosure of identifying information in violation of the Adoption Act is a Class A misdemeanor. (Section 18.8 of the Adoption Act)

 

n)         Any custodian of vital records will verify birth, death, marriage and divorce information presented to it by law enforcement agencies of federal, State, county and municipal governments of the United States and its territories and by federal, State, county and municipal government agencies, as well as consulates of foreign governments that administer health, welfare, safety or public assistance programs. [410 ILCS 535/3]

 

o)         To generate uniform birth records that will be accepted nationwide by all federal agencies, all states, and the U.S. territories, and that conform to national practices that support anti-fraud and homeland security efforts, the Department shall provide copies of birth records that use all capital letters as generated by the electronic Illinois Vital Records System.

 

(Source:  Amended at 46 Ill. Reg. 20036, effective November 30, 2022)

 

Section 500.22  Fee Waivers

 

a)         Department of Corrections and Department of Juvenile Justice:

 

1)         Search Fee Waivers.  The $10 search fee shall not be required for a birth record search from a person:

 

A)        Upon release on parole, mandatory supervised release, final discharge, or pardon from the Illinois Department of Corrections if the person presents a prescribed verification form completed by the Illinois Department of Corrections verifying the person's date of birth and social security number; or

 

B)        Placed on aftercare release under the Juvenile Court Act of 1987, upon release on parole, mandatory supervised release, final discharge, or pardon from the Illinois Department of Juvenile Justice if the person presents a prescribed verification form completed by the Illinois Department of Juvenile Justice verifying the person's date of birth and social security number (Section 25(1) of the Act).

 

2)         Applicants are entitled to only one search fee waiver.

 

3)         If, upon search, the record requested is found, the State Registrar shall furnish the applicant one certification of such record, under the seal of such office (Section 25(1) of the Act).

 

4)         Certified Copy Requests. An additional fee for a certified copy of the record shall not be required from a person:

 

A)        Upon release on parole, mandatory supervised release, final discharge, or pardon from the Illinois Department of Corrections if the person presents a prescribed verification form completed by the Illinois Department of Corrections verifying the released person's date of birth and social security number; or

 

B)        Placed on aftercare release under the Juvenile Court Act of 1987, upon release on parole, mandatory supervised release, final discharge, or pardon from the Illinois Department of Juvenile Justice if the person presents a prescribed verification form completed by the Illinois Department of Juvenile Justice verifying the person's date of birth and social security number; however, the person is entitled to only one certified copy fee waiver (Section 25(1) of the Act).

 

5)         The verification form may be used in lieu of an application. 

 

6)         An applicant shall present valid state government-issued identification.

 

b)         Homeless Fee Waiver:

 

1)         Applicable fees for a search for a birth record or a certified copy of a birth record shall be waived for all requests made by a homeless person whose status is verified (Section 25.3(b) of the Act).

 

2)         An individual's status as a homeless person shall be verified by a human services agency, legal services agency, or other similar agency that has knowledge of the individual's housing status, including, but not limited to:

 

A)        A homeless service agency receiving federal, state county, or municipal funding to provide those services or otherwise sanctioned by a local continuum of care;

 

B)        An attorney licensed to practice in the State;

 

C)        A public school homeless liaison or school social worker; or

 

D)        A human services provider funded by the State to serve homeless or runaway youth, individuals with mental illness, or individuals with addictions.

 

3)         A homeless person shall be provided no more than 4 birth records annually (Section 25.3(a) of the Act).

 

c)         Youth in Care Fee Waiver:

 

1)         The applicable fees for a search for a birth record or a certified copy of a birth record shall be waived for all requests made by:

 

A)        A youth in care, as defined by Section 4(d) of the Children and Family Services Act, whose status is verified.

 

B)        A person under the age of 27 who was a youth in care, as defined in Section 4d of the Children and Family Services Act, on or after his or her 18^th birthday and whose status is verified (Section 25.4(b) of the Act).

 

2)         An individual's youth status shall be verified by:

 

A)        A copy of the court order placing the youth in the guardianship or custody of the Department of Children and Family Services or terminating the Department of Children and Family Services' guardianship or custody of the youth; or

 

B)        by a human services agency, legal services agency or other similar agency that has knowledge of the individual's youth in care status, including, but not limited to:

 

i)          A child welfare agency, including the Department of Children and Family Services; or

 

ii)         The attorney or guardian ad litem who served as the youth in care's attorney or guardian ad litem during proceedings under the Juvenile Court Act of 1987 (Section 25.4(a) of the Act.

 

3)         An applicant under this Section shall be provided no more than 4 birth records annually (Section 25.3(a) of the Act).

 

(Source:  Added at 46 Ill. Reg. 20036, effective November 30, 2022)

 

Section 500.25  Gestational Surrogacy Births

 

a)         A process for establishing a parent-child relationship between a child and his or her intended parent or parents when the child is being carried by a gestational surrogate shall be completed prior to the birth of the child in accordance with Section 12 of the Vital Records Act, Section 6 of the Illinois Parentage Act of 1984, and the Gestational Surrogacy Act.

 

b)         At least one of the intended parents/co-parents must be the biological parent (egg or sperm donor) of the child being carried by the gestational surrogate.

 

c)         The name or names of the intended parent or parents, irrespective of gender or marital/civil union status, shall be entered on the child's birth record so long as the intended parent is a party to, or both intended parents are parties to, an otherwise lawful gestational surrogacy contract. 

 

d)         The names of the gestational surrogate and the gestational surrogate's husband/civil union partner, if any, are not placed on the child's birth certificate.

 

e)         All parties and spouses/partners involved in the surrogate arrangement must sign certified statements consenting to the establishment of the child's parentage (see Appendix J).

 

f)         A physician licensed to practice medicine in all its branches in the State of Illinois must sign a certified statement that the child being carried by the gestational surrogate is the child of the intended parent/co-parent or parents/co-parents and that neither the gestational surrogate nor the gestational surrogate's husband/civil union partner, if any, is a biological parent of the child being carried by the gestational surrogate. (Section 6(a) of the Illinois Parentage Act of 1984)

 

g)         The attorneys representing the intended parent/co-parent or parents/co-parents and the gestational surrogate and her husband/civil union partner, if any, must each sign a separate certified statement that the parties have signed a gestational surrogacy contract and that this contract satisfies the requirements of Section 25 of the Gestational Surrogacy Act. (Section 6(a) of the Illinois Parentage Act of 1984)

 

h)         The certified statements must be on forms prescribed by the Department and executed prior to the birth of the child (see Appendix J).

 

i)          The certified statement must be witnessed by two competent adults age 18 or older who are not the parties and spouses/civil union partners involved in the surrogate arrangement.

 

j)          The original certified statements, not photocopies, must be delivered to the director of medical records in the hospital of planned delivery prior to the birth of the child.  These original statements are to be placed in the medical record of the gestational surrogate. (Section 6(a) of the Illinois Parentage Act of 1984)

 

k)         If a surrogate birth occurs in an Illinois hospital other than the hospital planned for the delivery, the person preparing the birth certificate must be advised of the existence of the surrogate parentage statements. The birth record preparer should immediately contact the Department's Division of Vital Records, or the hospital where the birth was planned, for a copy of the surrogate parentage statements and also request that the original surrogate parentage statements be forwarded to the delivering hospital for inclusion in its medical records files.

 

l)          A photocopy of all of the certified statements shall be filed, at no charge, with the Department's Division of Vital Records prior to the birth of the child at the following address:

 

Illinois Department of Public Health

Division of Vital Records

925 East Ridgely Ave.

Springfield IL 62702-2737

 

m)        The Gestational Surrogacy Act does not apply if the gestational surrogate delivers the child outside of Illinois.

 

(Source:  Added at 37 Ill. Reg. 14983, effective August 28, 2013)

 

Section 500.30  Delayed Records of Birth

 

a)         Persons born within the State of Illinois for whom no prior registration of birth has been made and for whom no certificate of birth has been created may apply for and receive a certificate of birth provided all requirements of this Section are met.

 

b)         Application may be made by the person to whom the record relates if the applicant is eighteen (18) years of age or older on the date of application. A parent or legal guardian may make application on behalf of an applicant who is under eighteen (18) years of age on the date of application. Application shall be made on forms provided by the State Registrar and shall be filed with the local registrar of the district in which the applicant was born. For purposes of this Section, a foundling whose place of birth is unknown shall be presumed to have been born in the district in which found.

 

c)         The application shall include all information required by the application form, and shall be accompanied by documents which prove all facts necessary to complete the certificate of birth to the satisfaction of the State Registrar. In evaluating the proof submitted to substantiate the birth facts, the State Registrar shall take into consideration that documents created at the time of birth or immediately thereafter constitute the best evidence of the facts to be proved. Either the original document, a certified photograph or transcript of the original document, or a certified statement of the pertinent facts in a document may be accepted as proof. Documents shall show when and with what agency or official the information was originally recorded, including any particular identifying number and the complete address of such agency or official. If the birth occurred at home, the State Registrar may require the applicant to provide documents proving that the mother resided at the address where the child was born and that such residency included the date of birth of the child.

 

d)         The State Registrar may verify the authenticity and accuracy of any document submitted and any statement made to prove any fact necessary to complete the certificate of birth. In the event that the documents are not acceptable to the State Registrar, the applicant shall be so advised. If the State Registrar determines that a document has apparently been altered or may be counterfeit, law enforcement authorities shall be so informed. Applications which are incomplete, based upon misrepresentation, or are accompanied by documents which appear to be altered or counterfeit shall be rejected, and the birth record shall not be filed until a court determination of the facts has been made.

 

e)         The State Registrar may, but need not, return any documents, excepting only affidavits, to the persons who submitted the documents.

 

f)         If the name of the person whose birth is to be registered has ever been changed, the name at birth and the name later acquired shall be entered in the appropriate items on the application. A certified copy of the court order or decree shall be submitted if the name was acquired by court action; otherwise, a statement explaining the circumstances relating to the change of name shall be submitted.

 

g)         If the mother was not married to the father of the child either at the time of conception, birth, or any time in between, the name of the father shall not be entered on the birth record without the written consent of the mother and the person to be named as the father; unless a determination of paternity has been made by a court of competent jurisdiction, in which case a certified copy of the court order shall be submitted. The written consent may be furnished by separate statements by the mother and father, or by having both of them sign in the appropriate items on the application.

 

h)         If the child is more than three (3) days and less than one (1) year of age on the date of application, the local registrar may require the parent or legal guardian to appear in person with the child as a prerequisite to forwarding the certificate of birth to the State Registrar. The birth shall be registered on the current Certificate of Live Birth and shall be signed by:

 

1)         The physician in attendance at or immediately (within 72 hours) after the birth, or in the absence of such a person;

 

2)         Any other person in attendance at or immediately (within 72 hours) after the birth, or in the absence of such a person; or

 

3)         The father, the mother, or in the absence of the father and the inability of the mother, the person in charge of the premises where the birth occurred. (Section 12 of the Act).

 

i)          When the certificate is signed by the father, mother, or the person in charge of the premises, it shall be accompanied by a statement by the physician who later gave medical care, if any, or a sworn statement by a third party present at the delivery or having personal knowledge of the delivery.

 

j)          If the child is more than one (1) year and less than seven (7) years of age on the date of application, the Delayed Record of Birth shall be used and the Certificate of Live Birth shall not be used.

 

k)         If the child/adolescent is more than seven (7) and less than eighteen (18) years of age on the date of application, the Delayed Record of Birth shall be used and the Certificate of Live Birth shall not be used. Public school records or equivalent private school records which provide name, enrollment and attendance of applicant in the school and the name of parent or legal guardian of the applicant shall be submitted with the application in addition to other documents. Excepting school records, all documents shall be more than five (5) years old.

 

l)          If the applicant is eighteen (18) years of age or more on the date of application, the Delayed Record of Birth shall be used and the Certificate of Live Birth shall not be used. All documents shall be more than five (5) years old.

 

(Source:  Amended at 15 Ill. Reg. 11706, effective August 1, 1991)

 

Section 500.40  Amendments, Additions or Corrections to Vital Records

 

a)         The State Registrar shall endorse on the record or certificate the following additions and/or minor corrections made within one year after the date of occurrence without the certificate being considered amended.  Additions or minor corrections shall be made unless the change affects the integrity of the record (for example, a contradiction to existing documentation such as a hospital medical record).  For purposes of this Section, singular terms should be read to include the plural and vice versa, unless the context clearly indicates otherwise.

 

1)         Minor Birth Corrections include, but are not limited to:

 

A)        Additions and/or changes of given names of the registered person;

 

B)        Changes in the time of birth, if it does not change date of occurrence;

 

C)        Changes in the sex designation of the registered person within one year after the date of birth, if justified by the given name or based on the newborn delivery records from the hospital;

 

D)        Spelling errors or omissions of the parents' first or middle name;

 

E)        Parents' ages, if within two years of the age shown;

 

F)         Parents' places of birth, if the country is not different;

 

G)        Mother's residence and/or mailing address at the time of occurrence; or

 

H)        Spelling errors in the registered person's and/or parent's surname, if verified by a signature.

 

2)         Minor Death Corrections include, but are not limited to:

 

A)        Addition and/or changes of given names of the decedent;

 

B)        Changes in the sex designation of the decedent, if justified by the given names or if supported by a notarized statement of a licensed physician;

 

C)        Changes in ethnicity;

 

D)        Changes in either the age or birth date of the decedent (not both);

 

E)        Decedent's place of birth, if not a different country;

 

F)         Spelling errors or omission of the given or middle names of the marital spouse;

 

G)        Additions or changes in the social security number;

 

H)        Additions or changes in occupation/industry;

 

I)         Additions or changes in obvious errors of dates of service;

 

J)         Decedent's resident address;

 

K)        Spelling errors or omissions of the parents' first or middle names;

 

L)        Relationship and/or mailing address of informant;

 

M)       Date physician attended deceased;

 

N)        Notification of coroner or medical examiner; or

 

O)        Changes in hour of death, if date of death is not affected.

 

b)         When such additions or minor corrections are made by the State Registrar, a notation as to the source of information, together with the date the change was made, and the initials of the authorized agent making the change, shall be made in the margin of the record in such a way as not to become a part of the certifiable record.

 

c)         The State Registrar shall retain for six years, either in the original or microphotographic form, all source documents used as the basis for additions or minor corrections. The State Registrar shall also furnish a copy of the amended certificate or record to the custodian of any permanent local records, and the records shall be corrected accordingly.

 

d)         Once an item on the record or certificate has been corrected as a minor correction, all future amendments made to the same item shall be completed in accordance with the major correction guidelines.

 

e)         The State Registrar reserves the right to require proof to amend the record or certificate when the requested correction compromises the integrity of the vital record.

 

f)         Certificates filed pursuant to the Act, including those filed at the time of occurrence or shortly thereafter, "delayed" certificates filed under  Sections 14 and 19 of the Act, and "new" certificates filed under Section 17 of the Act shall be corrected or amended in accordance with this Section.

 

1)         A request for a major administrative correction of a certificate filed on or after January 1, 1916 shall be made to the State Registrar. A request for a major administrative correction of a certificate filed prior to that date shall be made to the county clerk of the county in which the birth, death or fetal death occurred. The request shall identify the certificate to be corrected by stating whether it is a birth, death or fetal death record. In addition, the name of the registered person, the date and place of the event, the items that are omitted or in error, and the correct information for those items shall also be submitted.

 

2)         After consulting the certificate in the files, the county clerk may initiate the correction form and send it to the applicant with instructions regarding who should sign and what documentary proof, if any, is required to support the correction sought.

 

3)         The persons who shall sign the correction form in the indicated order of priority are:

 

A)        To correct birth certificates:  the mother or father of the registered person, if the registered person is a minor; the registered person, if the person is of legal age; other next of kin or legal guardian; authorized official of a hospital, if the hospital record was the source of the personal particulars.

 

B)        To correct death or fetal death certificates:  the signators of the original certificate, i.e., the informant, physician, coroner/medical examiner, funeral director, decedent's spouse, mother, father, or other next of kin.

 

i)          The medical certification of death can be amended by the certifying physician, or the attending physician who was in charge of the patient's care for the illness or condition that resulted in death.

 

ii)         (Exception:  A correction to a Medical Examiner's/Coroner's Certificate of Death within one year after the initial registration of the death shall be accomplished by the Medical Examiner or Coroner filing an "Amended Certificate of Death.")

 

g)         Each copy of the correction form shall be individually signed. The affiants should sign their given names and present legal surnames and fill in the present complete address. The correction forms shall be signed in the presence of a person authorized to administer oaths, who shall date the form, sign in ink, affix his or her seal or stamp, and enter the complete address.

 

1)         Records created at or nearest following the date of birth provide the best proof to correct the child's given name or date of birth. Records created prior to the birth of the child are required to correct the given names of the parents, surname of the child and/or father, or mother's maiden name, color or race of parents, or age and birthplace of parents. Records created at or nearest following the decedent's birth provide the best proof to correct name, age, birth date, and birthplace. However, if such proof is not available, records created later in life may be accepted.

 

2)         To correct color or race on a death record, the best evidence is the decedent's birth or marriage record or birth certificate of a child of the decedent. To correct marital status, the best evidence is the decedent's marriage record, spouse's death record, or divorce decree, if any, or other court records. To correct a fetal death record, information on documents required for similar items on live birth and death certificates shall be furnished.

 

3)         To correct other items on a certificate, such documentary evidence shall be required as is deemed necessary to preserve the integrity of the certificate. More than one document may be required in some instances. Some corrections may not require documentary proof, depending on the nature of the correction and the identity of the affiant in relation to the registrant. The burden of submitting proof is on the applicant. The State Registrar shall make the final determination of whether the document submitted satisfactorily proves the correction sought. Any documents submitted, whether accepted or rejected as proof, shall be returned to the applicant, or his or her representative. Examples of available documents that substantiate facts are:

 

A)        Baptismal or confirmation records;

 

B)        Cradle roll certificates;

 

C)        1^st grade school records;

 

D)        Applicant's marriage record;

 

E)        Military records;

 

F)         Social security records;

 

G)        Child's birth record;

 

H)        Parents' marriage record;

 

I)         Parent's birth record(s);

 

J)         Immunization or clinic records;

 

K)        Insurance policies;

 

L)        Parent's Naturalization certificate;

 

M)       Census records; or

 

N)        Other documents as deemed appropriate.

 

h)         The original certificate of birth, death, or fetal death shall have the correction entered on its face by inter-lineation through the incorrect entries. The correct information is then typed or written above or near the incorrect information. A statement to the effect that the certificate has been amended, and the date, shall appear on the face of the certificate.

 

1)         The Department shall permanently retain the original of the correction form, either as an original record or in microphotographic form. An approved copy of the correction form, or an official copy of the certificate as corrected, shall be sent to the county clerk and local registrar, as their authority to correct their file copies of the certificate.

 

2)         The applicant shall be notified that the correction has been approved and made.

 

3)         Certifications or certified copies of the certificates as corrected will be furnished upon the written request of an eligible applicant as provided in Section 25 of the Act. If the applicant desires certified copies that do not show the previous entries regarding the items that were corrected, the applicant should request a short form certification; however, a statement to the effect that the certificate had been amended, and the date amended, shall appear on the certified copy.

 

i)          A correction form is not required to amend the surname on a birth certificate when the person has obtained a legal change of name from a court of competent jurisdiction. Legal name changes shall be reflected on a birth certificate if supported by a certified copy of the court decree. The new names will be entered on the original certificate in the files of the State Registrar by inter-lineation. The certificate shall be marked as having been amended and the decree number and the effective date entered. The State Registrar shall send the county clerk and local registrar official copies of the original certificate, as amended, to replace the copies in their files. Thereafter, any certifications or certified copies issued shall indicate that the certificate has been changed and the date of the amendment.

 

1)         The addition of the father's identity on the child's birth certificate, at the request of the birth father and mother, does not permit the changing of the child's surname to that of the father.

 

2)         Name Change Based on Naturalization

 

A)        The name of the informant (if parent), the name of the child and the name of the mother and/or father may be amended on the child's birth certificate, based upon a change of name granted to the parents by a naturalization court or other court of competent jurisdiction. This applies only if the name change was granted while the child was a minor.

 

B)        If the child is of legal age at the time of his/her parents' naturalization, the Division of Vital Records is authorized to amend only the informant's name (if parent) and/or the parents' names on the child's certificate of birth.

 

j)          The State Registrar shall amend a delayed birth registration established by court order under the provisions of Section 15 of the Act  only upon the basis of an order from the court that originally established the facts of birth. The procedure followed in amending the certificate and issuing copies is as described in subsection (i) regarding legal name changes.

 

k)         To change the given name of a child on a new birth certificate filed under Section 17 of the Vital Records Act (if the applicant has knowledge of the adoption), a certified copy of an amended Adoption decree or an amended Certificate of Adoption will be required as proof.

 

l)          A voluntary change of name, spelling of the given names or surname, or the order of the given names and/or surname as those names appear on the birth record shall not be reflected upon the birth record unless a request for the "correction" is accompanied by an appropriate court order.

 

m)        When a request for a correction constitutes change in identity of the registrant or the father or mother, a court determination is required to reflect the change on the birth record.

 

n)         The State Registrar shall not, at the request of any person, change a written signature on a record under the correction provisions. Such a change shall be reflected on the certificate only with a court determination.

 

o)         The State Registrar shall not, at the request of any person, change a file date on a certificate; therefore, the integrity of the record is protected.

 

p)         Provisions for the addition of the birth father's name and information to records:

 

1)         When the parents are not married:

 

A)        Both parents shall sign the major correction forms;

 

B)        A court order is needed to change the child's surname; and

 

C)        If either parent is deceased, a court determination shall be required to add the father's name and information to the record.

 

2)         When parents are married at the time of the child's birth:

 

A)        Both parents shall sign the major correction forms (the State Registrar will accept a certified copy of the divorce decree or death record and obituary notice in lieu of either parent's signature);

 

B)        A court order is needed to change the child's surname;

 

C)        The married name shall be added to the end of mother's name (if the mother is shown as an informant on record);

 

D)        Legitimacy status shall be changed on the record.

 

(Source:  Amended at 35 Ill. Reg. 16682, effective October 3, 2011)

 

Section 500.43  Amendments to Birth Records Following Gender Re-assignment

 

Changes to gender on birth records following an operation having the effect of reflecting, enhancing, changing, reassigning or otherwise affecting gender designation on an existing Illinois birth record shall be governed by this Section. A person born in Illinois, with an existing Illinois birth record, may submit an application to the Department seeking to have the gender changed on his or her own birth record after undergoing an operation having the effect of reflecting, enhancing, changing, reassigning or otherwise affecting gender. The burden of proof shall be on the applicant to clearly demonstrate that he/she has met the gender change criteria set forth in this Section.

 

a)         Except as provided in subsection (b), all requested changes shall be supported by an affidavit of a physician, licensed to practice medicine in Illinois or any other State.  The physician's affidavit shall clearly state that he or she has performed an operation on the applicant that has reassigned the gender of the applicant, and that, by reason of the operation, the sex designation on the applicant's birth record (certificate) should be changed.  (Section 1(9) and 17(d) of the Act)  The affidavit shall specify the name of the operation or operations that justify the change in gender on the applicant's birth record. 

 

b)         Applicants who have undergone a gender reassignment operation outside of the United States shall submit an affidavit signed by an examining physician duly licensed to practice medicine in Illinois or any state in the United States.  The affidavit shall clearly establish that the examining physician personally examined the applicant and shall clearly state that the identified operation previously performed has reassigned the applicant's gender and justifies a change in the applicant's gender on his/her birth record.

 

c)         The Department shall specify the form of the application and supporting affidavits and shall have the authority to request additional information and documentary proof, including copies of certified medical or other records.

 

d)         Name changes shall comply with separate criteria for name changes in this Part.

 

(Source:  Added at 35 Ill. Reg. 16682, effective October 3, 2011)

 

Section 500.45  New Certificates of Birth

 

This Section is based upon Section 17 of the Act. In the following instances, a new birth certificate shall be prepared (if requested) upon receipt of a Certificate of Adoption or a certified copy of the order of adoption and shall be filed by the State Registrar. Preparation of the new certificate is contingent upon the receipt of proper evidence. An amendment of a Certificate of Live Birth shall not be made in the following instances:

 

a)         Legal adoption (in Illinois or elsewhere) of a person born in Illinois;

 

1)         Upon receipt of a Certificate of Adoption or a certified copy of the order of adoption pertaining to a single parent adoption, the Certificate of Live Birth shall reflect the following:

 

A)        Mother adopts a child or an adult. The State Registrar shall enter in the item designation for father, "Single Parent Adoption," or "Single Parent," or leave this space blank.

 

B)        Father adopts a child or an adult. The State Registrar shall enter in the item designation for mother, "Single Parent Adoption," or "Single Parent," or leave this space blank.

 

2)         When alterations or discrepancies appear on the Certificate of Adoption regarding the name of the child (after adoption) or the adoptive parents' names, the State Registrar may review a certified copy of the adoption decree to determine the correct names. The State Registrar may, as an alternative, be presented with an amended Certificate of Adoption certified by the clerk of the court, showing no alterations. The State Registrar may require additional information and/or documentation in order to verify other alterations and/or discrepancies found on the Certificate of Adoption.

 

3)         Discrepancies in the date of birth between the natural birth record and the Certificate of Adoption shall be resolved by utilizing the date shown on the natural birth record, unless otherwise specified in the court decree, or other documentation. If in the judgment of the State Registrar, changing the date of birth to that of the natural birth record could reveal the adoptive status to the adoptee, the State Registrar may show the date of birth as indicated on the Certificate of Adoption.

 

4)         In addition to the Certificate of Adoption, a certified copy of the adoption decree must be submitted to the State Registrar if it has been discovered that an adoptive parent was deceased at the time of adoption. The State Registrar will determine if there is legal authority to show that parent on the new birth record. If the certified copy of the adoption decree does not indicate the name of the deceased parent, the State Registrar shall require an amended decree of adoption.

 

5)         In the absence of an original birth record on file, the State Registrar may prepare a birth record using the adoption decree which must establish the date of birth, place of birth, and parentage. The file date shall be shown as the date the decree was granted.

 

6)         If the adoption decree failed to establish the date of birth, place of birth and parentage, a Delayed Record of Birth shall be filed. The file date on the new Certificate of Live Birth shall be shown as the date the decree was granted.

 

7)         During the preparation of the new certificate, the State Registrar may verify from the adoptive parent(s), if necessary, how the informant's name is to be shown on the certificate.

 

8)         The new birth certificate shall parallel an original certificate and by legal fiction purport in the case of an adoption, that the adoptive parents are the natural parents.

 

b)         Intermarriage of the natural parents after the child's birth or birth registration;

 

1)         Prior to preparing a new Certificate of Live Birth for a child whose natural parents married subsequent to his/her birth, the State Registrar shall require the following:

 

A)        Affidavits completed by the mother and natural father, properly signed and notarized.

 

B)        A certified copy of the marriage record.

 

2)         When one or both of the parents are deceased, a certified copy of the death record along with a notarized statement from a member of the decedent's family, in lieu of the required affidavit, is needed. If a statement from the family is not obtainable, a copy of the deceased parent's obituary notice, insurance policy, will or letters of estate administrator may be substituted.

 

3)         When the natural birth certificate lists a disputed father and the applicant requests the State Registrar to establish a new Certificate of Live Birth, based upon the legitimation provision of the Vital Records Act, the State Registrar shall review the divorce decree of that previously dissolved marriage. This is necessary in order to determine if there is administrative authority to remove the name of the father listed on the natural birth record. If there is sufficient evidence to remove the name of the previous husband, the State Registrar shall establish a new Certificate of Live Birth based upon affidavits of mother and natural father and their certified copy of marriage.

 

4)         If this paternity issue cannot be established through administrative authority, the decision of paternity would first require court determination prior to establishing a new Certificate of Live Birth.

 

5)         The State Registrar's authority to prepare birth certificates does not permit a determination of an issue or question of paternity of a child on mere affidavits.

 

6)         During the preparation of the new certificate, the State Registrar may verify from the parents, if necessary, how the informant's name is to be shown on the certificate.

 

c)         Determination of paternity by a court of competent jurisdiction;

 

            During the preparation of the new certificate, the State Registrar may verify from the parents, if necessary, how the informant's name is to be listed on the certificate. The informant's name should never be shown as a name different than the facts relevant to the preparation of the new record.

 

d)         Change of sex designation following surgery by a physician;

 

1)         For cases pertaining to adoption, legitimation, paternity or sex designation changes, the original birth certificate and copies of the original certificate from the local custodians' files shall be impounded and placed in a sealed file with related correspondence and documents. The new birth certificate shall be placed in the official State files, and copies of it shall be sent to the local custodians for their files. Thereafter, any certifications or certified copies issued shall be of the new certificate.

 

2)         In the event that a new Certificate of Live Birth is established by the Department based upon legal adoption, legitimation, paternity, or sex designation changes and the Department is thereafter presented with proper evidence that the Certificate of Live Birth may have been incorrectly withdrawn from the official State files and impounded, the Department shall open the impounded file and inspect its contents. If the Department determines from the contents of the impounded file and from the evidence presented that a mistake occurred with respect to the identity of the original record, the Department may restore the Certificate of Live Birth to the official State file and return copies to the local custodians for filing. In such cases, the new Certificate of Live Birth prepared upon the basis of legal adoption, legitimation, paternity or sex designation changes shall remain in the official State file. However, the Department shall use the appropriate State file number on the new Certificate of Live Birth.

 

3)         If a court of competent jurisdiction enters a decree or order in which it finds that it is in the best interest of a person for whom a new birth certificate has been established, that the original birth certificate be restored, the State Registrar, upon receipt of a certified copy of such order or decree, shall restore the original Certificate of Live Birth to its place in the files, and the new certificate and evidence shall not be subject to inspection or certification, except upon order of a court of competent jurisdiction.

 

4)         The copies of the original birth certificate shall be returned by the State Registrar to the custodians of local records who shall replace them in their official files and surrender the copy of the newly prepared birth record to the State Registrar to be sealed from inspection.

 

(Source:  Added at 15 Ill. Reg. 11706, effective August 1, 1991)

 

Section 500.47  Illinois Adoption Registry and Information Exchange

 

a)         As used in this Section:

 

            "Adopted person" means a person who was adopted pursuant to the laws in effect at the time of the adoption (Section 18.06 of the Adoption Act).

 

            "Adoptive parent" means a person who has become a parent through the legal process of adoption (Section 18.06 of the Adoption Act).

 

            "Agency"  means  a  public  child welfare agency or a licensed child welfare agency (Section 18.06 of the Adoption Act).

 

            "Birth  father"  means  the  biological  father  of  an adopted  or surrendered person who is named on  the original certificate  of  live birth  or  on  a  consent  or surrender document, or a biological father whose paternity has been established by  a  judgment  or  order  of  the court, pursuant to the Illinois Parentage Act of 1984 (Section 18.06 of the Adoption Act).

 

            "Birth  mother"  means  the  biological  mother  of  an adopted  or surrendered person (Section 18.06 of the Adoption Act).

 

            "Birth parent" means a birth mother or birth father of an adopted or surrendered person (Section 18.06 of the Adoption Act).

 

            "Birth  sibling"  means the adult full or half sibling of an adopted or surrendered person (Section 18.06 of the Adoption Act).

 

            "Council" means the Adoption Registry Advisory Council created under Section 18.07 of the Adoption Act).

 

            "Denial of Information Exchange" means an affidavit completed  by  a registrant  with  the Illinois Adoption Registry and Information Exchange denying the release of identifying information (Section 18.06 of the Adoption Act).

 

            "Department" means the Department of Public Health.

 

            "Information Exchange Authorization" means an affidavit completed by a registrant with the Illinois Adoption Registry and Information Exchange authorizing the release of identifying information (Section 18.06 of the Adoption Act).

 

            "Medical Questionnaire"  means the  medical history questionnaire completed by a registrant of the Illinois Adoption Registry and Information Exchange (Section 18.06 of the Adoption Act).

 

            "Proof of death" means a certified copy of a death certificate (Section 18.06 of the Adoption Act).

 

            "Registrant" or "registered  party"  means  a  birth parent,  birth sibling,  adopted  or surrendered person over the age of 21, or adoptive parent or legal guardian of an adopted or surrendered person  under  the age  of  21  who has filed an Illinois Adoption Registry Application or Registration Identification Form with the Registry (Section 18.06 of the Adoption Act).

 

            "Statistical records" mean non-identifying numerical data tallying the total number of registrations filed by adopted persons, surrendered persons, non-surrendered birth sibilings, adoptive parents, birth parents, and legal guardians; and the total number of registry matches made.

 

            "Surrendered person" means a person whose parents' rights have  been surrendered or terminated but who has not been adopted (Section 18.06 of the Adoption Act).

 

b)         The Department of Public Health will:

 

1)         Maintain the Illinois Adoption Registry, Information Exchange, and  the Medical  Information  Exchange under the Adoption Act to assist the voluntary exchange  of information between mutually consenting birth parents or birth siblings and mutually consenting adoptive parents or legal guardians of adopted or surrendered persons under the age of 21 or adopted or surrendered  persons  21  years  of  age or older.

 

2)         Inform the public about the Adoption Registry and information exchanges through public service announcements, media coverage and, for a minimum of  4 years, through  notices   enclosed   with  driver's license renewal applications.

 

3)         Notify all parties who registered with the Illinois Adoption Registry before January  1, 2000 of the Adoption Registry and Medical Information Exchange.

 

4)         Maintain an informational Internet site where interested parties may access information about the Illinois Adoption  Registry and Information Exchange and download all necessary  application forms.

 

5)         Maintain or aggregate statistical  records and informational material  regarding the  Registry and Registry participation for periodic distribution to the public.

 

c)         Effective with the establishment of an Adoption Registry and Medical Information Exchange, the Department will provide information about Adoption Registry services.  The address and telephone number of the Adoption Registry is as follows:

 

            Adoption Registry

            Illinois Department of Public Health

            Division of Vital Records

            605 W. Jefferson

            Springfield, Illinois 62702-6553

            [Toll free] 877-323-5299 or 217-557-5159

 

d)         When  a person registers with the Illinois Adoption Registry and  completes  an  Illinois  Adoption   Registry Application or a Registration  Identification  Form, the Registry shall establish a new Adoption/Surrender Records File for that person.  An established  Adoption/Surrender Records  File  shall  be limited to the following items:

 

1)         The General Information Section of an Illinois Adoption Registry Application, the Registration Identification Form, the Medical Questionnaire, and the Information Exchange Authorization or Denial that have been voluntarily completed by the adopted or surrendered person or his or her adoptive parents, legal guardians, birth parents, or birth siblings.  The Department of Public Health shall act according to the most recently filed authorization or denial unless that authorization or denial has expired under subsection (f).

 

2)         Photographs and written statements voluntarily provided by a registrant for the  adopted  or  surrendered person or his or her adoptive parents, legal guardians, birth parents, or birth siblings.  The photographs shall be submitted in an unsealed envelope no larger than 8 1/2" x  11" and shall  not  include identifying information about a person other than the registrant who submitted them. Identifying information submitted about persons other than the registrant  shall  be redacted by the Department or the information shall be returned to the registrant for removal of that identifying information.

 

3)         Any  Information  Exchange  Authorization  or  Denial of Information Exchange that has been filed by a registrant.  The Department of Public Health shall act according to the most recently filed authorization or denial unless that authorization or denial has expired under subsection (f).

 

4)         For  all adoptions finalized after January 1, 2000, copies of the original certificate of live birth  and the  certificate  of adoption.

 

5)         Updated  addresses  submitted  by  a registered party about himself or herself.

 

6)         Proof of death that has been submitted by an  adopted or  surrendered  person,  adoptive  parent,  legal guardian,  birth parent, or birth sibling.

 

e)         The Department will establish and maintain  a Registry to in writing only provide  identifying  information  to mutually consenting adult adopted or surrendered persons, birth parents, adoptive  parents,  legal  guardians,  and  birth  siblings.  Before identifying information is released, the Deputy State Registrar and Adoption Registry director must review and only approve the exchange of identifying information if the release is allowed under the requirements of this Part and the Adoption Act. Identifying information includes the following items:

 

1)         The name and last known address of the  consenting person or persons.

 

2)         A  copy  of  the Illinois Adoption Registry Application of the consenting person or persons.

 

3)         A copy of the original certificate of live  birth of  the adopted person. Written  authorization  from all parties identified must be received before the disclosure of the respective party's identifying information.

 

4)         A copy of the completed Medical Questionnaire.

 

f)         After a child is surrendered for  adoption, during  the adoption  proceedings, or after the adoption, either birth parent or both birth parents may file with the Registry  a Birth Parent  Registration  Identification  Form  and  an Information Exchange Authorization or a Denial of Information Exchange.

 

            A birth sibling 21 years of age or older who was not surrendered for adoption, and who has submitted proof of death for a deceased birth parent who did not file a Denial of Information Exchange with the Registry before his or her death, may file a Registration Identification Form and an Information Exchange Authorization or a Denial of Information Exchange.  If the birth sibling of an adopted or surrendered person was not born in Illinois, then that birth sibling must submit a certified copy of his or her birth certificate with the registration.

 

            An adopted person over the age of 21 or still under guardianship, or a surrendered person over the age of 21, or an adoptive parent or legal guardian of an adopted or surrendered person under the age of 21 may file with the Registry a Registration Identification Form and an Information Exchange Authorization or a Denial of Information Exchange.  If registering as the legal guardian of an adopted or surrendered person, then a certified copy of the court order establishing the guardianship must be submitted with the registration.  If an adoptive parent or legal guardian of an adopted or surrendered person under the age of 21 files a registration, authorization, or denial, then that registration, authorization, or denial expires when the adopted or surrendered person attains 21 years of age unless the guardianship extends beyond that time, in which case the registration expires when the guardianship expires.  After expiration, the Department shall then not release any Registry information and shall close that adoption/surrender records file until the now competent adult adopted or surrendered person files with the Registry a Registration Identification Form,  Information Exchange Authorization, or Denial of Information Exchange.

 

g)         The Department will supply to the adopted  or surrendered person, or his or her adoptive parents or legal guardians, and to the birth parents identifying information only if both the adopted or surrendered person, or his or her adoptive parents or legal guardians, and the  birth  parents have filed with the Registry an Information Exchange Authorization and the information at the  Registry indicates  that  the consenting  adopted or surrendered person or the child of the consenting adoptive parents or legal guardians is the child of the consenting birth parents.  The  Department will  supply  to adopted or surrendered  persons who are birth siblings identifying information only if both siblings have filed with the Registry  an  Information  Exchange Authorization  and the  information  at the Registry indicates that the consenting  siblings  have  one  or  both  birth  parents in common.  Identifying  information will be supplied to consenting birth siblings who were adopted or surrendered if the consenting sibling is 21 years  of  age or  older. Identifying information will be supplied to consenting birth siblings who were not adopted or surrendered if the consenting sibling  is  21 years  of  age or older, has proof of death of the common birth parent, if one birth parent was in common or proof of death of both parents if both were in common, and the common birth parent or common birth parents did not file a Denial of Information Exchange with the Registry before his or her death.

 

h)         A birth parent, birth sibling, adopted or surrendered person, or adoptive parents or legal guardians may notify the Registry of their desire not to have their identity revealed or may revoke any previously filed Information Exchange Authorization or Medical Questionnaire/Medical Information Exchange Release  by  completing  and filing  with  the  Registry  a Registry Identification Form along with a Denial  of  Information  Exchange or modified Information Exchange Authorization.  The Illinois   Adoption   Registry Application  does  not need to be completed to file a Denial of Information Exchange.  An adopted or surrendered person or his  or  her adoptive  parents  or legal guardians, birth sibling, or birth parent may revoke a  Denial  of Information  Exchange or Denial of Medical Information Exchange Release by  filing  an  Information Exchange Authorization.   The Department of Public Health shall act according to the most recently filed authorization or denial unless that authorization or denial has expired under subsection (f).

 

i)          Information  submitted  to  the Registry is confidential and gathered by the State to assist the exchange of updated medical data and contact information between adopted and surrendered persons and other registered parties. Information exchanged through the Registry is not admissible as evidence nor discoverable in an action in a court, tribunal, board, agency, or  commission, except as provided in subsection (i)(1).  Disclosure  of information in violation of the Adoption Act is a Class A misdemeanor (see Section 18.8 of the Adoption Act).

 

1)         Information from the Registry may not  be  disclosed, except as authorized by the Adoption Act, including under Section 18.1(f) of that Act, only:

 

A)        Upon a Court Order, which order shall name the person or persons entitled to the  information.

 

B)        To  the adopted  or  surrendered person, adoptive parents or legal guardians, birth sibling,  or birth  parent  if both  the  adopted  or surrendered  person, or his or her adoptive parents or legal guardians, and his or her birth parent, both birth parents, or birth siblings, have filed  with the Registry an Information Exchange Authorization and have otherwise met the conditions of this Part.

 

C)        As authorized under Section 18.3(h)  of  the Adoption Act.

 

D)        If requested by an adopted person, a copy of the certificate of live birth shall only be released to the adopted person under the conditions of this Part if he or she was  born in  Illinois and is the subject of an Information Exchange Authorization filed by one of his or her  birth parents or non-surrendered birth siblings.

 

2)         A person who willfully provides unauthorized disclosure of information filed with the  Registry  or who knowingly or intentionally files false information with the Registry is  guilty  of  a Class  A  misdemeanor and is liable for damages under Section 18.1(f) of the Adoption Act.

 

3)         Identifying information submitted about persons other than the registrant  shall  be redacted by the Department or the information shall be returned to the registrant for removal of that identifying information. The Department shall redact identifying information provided to it about a party who has not consented to the disclosure of the identifying information.

 

j)          Upon meeting the requirements of this Part, the Registry shall release identifying information in writing only as specified  on the Information Exchange Authorization to the following mutually consenting  registered parties and provide  them with photographs that have been placed in the Adoption/Surrender Records File and are specifically intended for the registered parties:

 

1)         An  adult  adopted or surrendered person and one of his or her birth parents or birth siblings who have both filed with the Registry an Information Exchange Authorization specifying the  other consenting party, if information available to the Registry confirms that the consenting adopted or surrendered  person is a birth relative of the consenting birth parent or sibling.

 

2)         The  adoptive  parent  or legal guardian of an adopted or surrendered person under the age of 21 and one of his or  her  birth parents  or  birth  siblings who  have  both  filed with the Registry an Information Exchange Authorization specifying the other  consenting  party if the information available to the Registry confirms that  the  child  of the consenting adoptive parent or legal guardian is a birth relative of the consenting birth parent or birth sibling.

 

3)         If a registrant has completed a Medical Questionnaire  and  has  consented to its disclosure, that Questionnaire shall be released to any registered party who has indicated his/her desire to receive the information on his or  her  Illinois Adoption  Registry Application  if information available to the Registry confirms that the consenting parties are birth relatives  or  that  the  consenting birth relative  and  the  child  of  the consenting adoptive parents or legal guardians are birth relatives.

 

A)        If a registrant is the subject of a Denial of Information Exchange filed by another party to the adoption, the Registry shall not release identifying information to either registrant.

 

B)        If a registrant is the subject of a Denial of Medical Information Exchange filed by another party to the adoption, the Registry shall not release the Medical Questionnaire to either registrant.

 

k)         The forms for the Adoption Registry Application, Birth Parent Registration  Identification, Adopted Person Registration Identification, Surrendered Person Registration Identification, Non-surrendered Birth Sibling Registration Identification, Adoptive Parent Registration Identification, Legal Guardian Registration Identification, Information Exchange Authorization, Denial of Information Exchange, and Medical Questionnaire are included as Illustrations in Appendix E of this Part.

 

1)         Registration with  the Illinois Adoption Registry and Medical Information Exchange is effective upon the filing with the Registry of the  applicant's  completed Illinois  Adoption Registry Application.  Registration and changes must be made using the prescribed forms.  The Department shall send to a registrant a written confirmation of the registration or subsequent changes.  No other information pertaining to the receipt or status of a registrant's application shall be released without the registrant's written request and proof of identification.

 

2)         When  an  Illinois  Adoption  Registry Application, Information Exchange Authorization, or a Denial of Information Exchange or Release  is  executed in a foreign country, the execution must be acknowledged or affirmed before an officer of the United States consular services.  If the person signing an Information Exchange Authorization  or a Denial of Information is in the military service of the United States, the execution of the document may be acknowledged before a commissioned officer  and  the signature of the officer on the certificate must be verified or acknowledged  before  a  notary  public  or by  other procedure of the armed forces.

 

3)         A registrant may complete all or any part of the Illinois Adoption Registry form.  The Illinois Adoption Registry forms, required documents, and affidavits submitted to the Registry shall be accompanied by a copy of proof of identification.  Accepted forms of identification include a driver's license, state or federal identification card, military identification card, passport, or other government issued identification card with a photograph, but does not include a firearm owner's identification card.

 

4)         The registrant must pay a $40 fee for registering with the Illinois Adoption Registry and Information Exchange. This fee will be waived, however, for all adopted or surrendered persons, adoptive parents, legal guardians, birth  parents, and birth siblings who complete a Medical Questionnaire at the time of registration and authorize its release to specified registered  parties,  and  for  adoptive parents registering within 12 months after the finalization of the  adoption.  In addition, the Department will not charge a fee for the update, withdrawl, or revocation of a form.

 

l)          The Adoption Registry Advisory Council is chaired  by  the Director  of  Public Health or the Director's designee.  The Council will:

 

1)         Advise  the  Department  on  the  development  of rules, procedures, and forms used by the Illinois Adoption Registry and Information Exchange.

 

2)         Make recommendations regarding the procedures, tools  and technology that will ensure efficient and effective operation of the Registry.

 

3)         Submit a report of statistical records to the Governor and General Assembly.

 

4)         Assist the Department with the development, publication, and circulation  of  an informational  pamphlet that describes the purpose, function, and mechanics of the Illinois Adoption  Registry and Information Exchange, including information about who is eligible  to  register  and  how  to register; information about the questions and  concerns that registrants  may  develop  when  they register  or  when they receive information from the Registry; and a list of services, programs, groups, and informational websites  that are  available  to  assist  registrants  with their  questions  and concerns.

 

(Source:  Amended at 24 Ill. Reg. 11882, effective July 26, 2000)

 

Section 500.50  Death Reporting, Transportation and Disposition of Dead Human Body

 

a)         A local registrar may issue a Permit for Disposition of Dead Human Body to a funeral director authorizing a hospital to incinerate a dead fetus (a product of gestation of 20 or more weeks) or the body of an infant who dies immediately after birth and prior to release from the hospital.  This permit may be issued only by a local registrar to a funeral director upon the filing of the appropriate death or fetal death certificate.

 

b)         A local registrar may issue a Permit for Disposition of Dead Human Body authorizing the parents of a dead fetus or deceased infant to bury the body in a private burial plot, if requested by a funeral director.  This permit may be issued only to the funeral director and only upon the presentation of a completed Certificate of Death or Fetal Death.

 

c)         A Permit for Disposition of a Dead Human Body authorizing disinterment is required prior to the disinterment of a dead human body or fetus.  The same permit may also authorize transportation of the body by common carrier, if desired.  The permit shall be issued by the local registrar of the Local Registration District in which the disinterment is to be made and shall be issued only to a funeral director.  The application for disinterment shall be signed by the surviving spouse of the decedent or, if none, a surviving adult child of the decedent or, if no surviving spouse or adult children, then a parent or sibling of the decedent.  If the surviving spouse, surviving adult child, adult children, or a parent or adult sibling of the decedent does not consent, a court order will be required. If the applicant is a surviving adult child and there is no surviving spouse, all other surviving adult children, except for the applicant, must either sign the application for disinterment or be notified by Certified U.S. Mail prior to the issuance of the permit for disinterment. When notification of a disinterment request is required, the local registrar in the registration district where the remains are currently located shall send the notification by certified mail. This notification shall include a copy of the requestor's completed disinterment/reinterment application (VR 207). The notification will indicate that the surviving relative's signature on the copy of the application included with the certified mail is required to approve the disinterment request. The notification shall also indicate the disinterment request will not be approved unless the surviving relative's signature is on the application and returned to the local registrar within 30 days of the date on the certified notification. Investigations conducted by the coroner, medical examiner, state's attorney or any other related law enforcement official do not require the signature or approval from the next of kin, and the application for disinterment must be signed by the coroner, medical examiner, state's attorney or other related law enforcement official, or by order of the Illinois Circuit Court. If multiple bodies or an entire cemetery is to be disinterred, the local registrar may issue a single Permit for Disposition of Dead Human Body to a funeral director, to which a complete list, as far as possible, of the identity of all the bodies is to be attached.  The Permit for Disposition of Dead Human Body authorizing disinterment shall also show the final disposition of the body or bodies. If the disinterred remains are to be cremated, the medical examiner or coroner in the county of disinterment shall have the authority to issue a cremation permit.

 

1)         Disinterred human remains shall not be transported within the State unless accompanied by a Permit for Disposition of Dead Human Body.  The transportation of disinterred remains by common carrier or by private conveyance is subject to the requirements of subsections (e)(1) through (6) that apply to any dead human body.  The remains of repatriated U.S. war dead may be transported within Illinois on the basis of the burial-transit permit issued at the point of origin.  The permit shall be exchanged for an Illinois Permit for Disposition of Dead Human Body prior to interment or cremation in Illinois (see subsection (d)(6)).

 

2)         Disinterred human remains shall not be reinterred within the State except as authorized by a Permit for Disposition of Dead Human Body.

 

d)         Disposition of Dead Human Body

 

1)         A dead human body shall not be interred in a grave, vault or tomb, except as authorized by a Permit for Disposition of Dead Human Body.  If the death occurred in the State of Illinois and burial is also in this State, a funeral director may issue the permit. When the body is being shipped out of State for disposition or when the death was subject to investigation by the medical examiner or coroner, the permit must be signed prior to the disposition of the body by the local registrar of the district where the death occurred.  A dead human body shall not be surrendered to a physician, surgeon, medical college or school or other institution or school of mortuary science and later cremated, except as authorized by a Permit for Disposition of Dead Human Body issued by the local registrar of the district in which the death occurred. This permit shall be issued to a funeral director upon presentation of a completed Certificate of Death or Certificate of Fetal Death.  A dead human body shall not be donated to a physician, surgeon, medical college or school or other institution or school of mortuary science without the applicable permit (VR 204) authorized by the local registrar in the registration district where the death occurred. The signed donation permit must be signed by the local registrar prior to the donation. When it is known that a cremation of the remains will occur after the donation is completed, a signed cremation permit (VR 204.1) is required to cremate. To obtain a signed cremation permit, the funeral director will present a completed Certificate of Death or Certificate of Fetal Death to the medical examiner/coroner in the county where the death occurred. Upon review of the permit and the completed Certificate of Death or Certificate of Fetal Death the medical examiner/coroner will determine whether to authorize the cremation. Approved and signed VR 204.1 permits shall be returned to the funeral director. 

 

2)         A dead human body being shipped out of State for disposition, or whose death was subject to the coroner's or medical examiner's investigation, shall not be disposed of, except as authorized by the signing of Part II of the Report of Death (VR 205) by the local registrar of the district in which the death occurred.  If disposition of a dead human body is by cremation, the local registrar shall not sign the permit, unless presented with a duly executed Coroner's or Medical Examiner's Permit to Cremate a Dead Human Body.

 

3)         No Permit for Disposition of Dead Human Body is required for the disposition of ashes from cremation, unless the ashes are to be buried in a cemetery.  In that case, any local registrar or any funeral director may issue the permit.

 

4)         No Permit for Disposition of Dead Human Body is required for the disposal of a part of a living human body, such as an amputated arm or leg, except when the part is to be interred in a cemetery.  In that case, upon being requested to do so, the local registrar of the registration district where the cemetery is located shall issue a Permit for Disposition of Dead Human Body. The permit shall be issued upon receipt of a letter from the institution that performed the amputation or is in custody of the amputated part or parts.

 

5)         A dead fetus resulting from a fetal death (see 410 ILCS 535/1) is considered to be a dead human body, and its transportation and disposition are subject to this Part. However, if the dead fetus was delivered before the 20^th week of gestation, a Permit for Disposition of Dead Human Body is not required unless interment of the remains is to be made in a cemetery.  In that case, if the fetal death was not subject to a medical examiner or coroner's investigation, any funeral director can issue the permit. If the fetal death was subject to a coroner's investigation, the local registrar of the district where death occurred shall sign the permit.

 

6)         A permit for a group burial or group cremation (when the manner of death is "Natural") for fetuses under 20 weeks gestation may be issued without the completion and filing of a Certificate of Fetal Death.

 

A)        In the case of group burial, when the fetal death is under 20 weeks gestation and not subject to coroner's or medical examiner's jurisdiction, a burial or transit permit can be issued by any funeral director without a Certificate of Fetal Death.

 

B)        In the case of group cremation, when the fetal death is under 20 weeks gestation and not subject to coroner's or medical examiner's jurisdiction, hospital personnel will provide copies of the signed Fetal Death Disposition-Notification Form for each fetus to a funeral director to be presented to the coroner or medical examiner in the county where the fetal death occurred. The coroner or medical examiner will issue one cremation permit for all fetuses or individual cremation permits for each fetus in the group cremation. Upon receipt of the authorized cremation permit or permits, any funeral director will then issue the Permit for Disposition of Dead Human Body (VR 205).  The funeral director will provide the VR 205 and the authorized cremation permit to the local registrar in the registration district where the fetal death occurred.  The local registrar shall sign the VR 205.

 

C)        In any case that the coroner or medical examiner deems necessary to investigate and to certify the cause of death, a Fetal Death Certificate shall be completed and filed irrespective of the fetus' weeks of gestation. 

 

7)         A Permit for Disposition of Dead Human Body authorizing the disposition of the remains of the repatriated U.S. war dead shall be issued to the receiving funeral director by the local registrar of the district in which the body is to be interred or cremated.  The Permit for Disposition of Dead Human body shall be issued in exchange for the burial-transit papers accompanying the body.

 

e)         Transportation of Dead Human Body

 

1)         When a death occurs in Illinois, during the first 24 hours after notification of the death, the funeral director may move a dead body that is not subject to a medical examiner or coroner's investigation from the place of death to a mortuary in the State without first having obtained a Permit for Disposition of Dead Human Body.

 

2)         No dead human body may be transported into the State of Illinois, unless it is accompanied by the Burial-Transit Permit (VR 205) properly issued in accordance with the laws of the state from which the body was transported, showing that all precautions required by the State of Illinois have been observed.  The burial-transit permit is sufficient authority also for interment or cremation of the body in Illinois, provided that the permit specifies the place and type of disposition, except in municipalities where local ordinance requires the issuance of a local permit prior to disposition, and except for repatriated U.S. war dead.

 

3)         No dead human body shall be transported by common carrier in Illinois, unless accompanied by a Permit for Disposition of Dead Human Body issued by a local registrar of this State.  In the case of a body shipped from another state, the body shall be accompanied by a transit or burial-transit permit issued in accordance with the laws of the state from which the body is shipped.

 

4)         No dead human body shall be transported from Illinois to a point outside this State unless the body has been prepared in accordance with the laws and regulations of the states through which and to which transportation is made.

 

5)         Presumptive records of death prepared upon the order of a court of competent jurisdiction shall show, as the date of death, the date the order was entered by the court, unless otherwise specified in the order.

 

6)         No permit for transportation signed by the local registrar is required prior to transporting a dead human body out of the State of Illinois, at the direction of a federally designated organ procurement organization, for the purpose of organ or tissue donation.  The dead human body being transported for the purpose of organ or tissue donation shall be accompanied by a self-issued VR 206 permit.  The VR 206 permit shall be completed by an Illinois-licensed funeral director and embalmer or an Illinois-licensed funeral director and shall serve as notification to the county medical examiner or coroner of the jurisdiction or county in which the death occurred that the dead human body is being transported out of Illinois for a period not to exceed 36 hours.  This subsection (e)(6) applies only to instances in which the dead human body is to be returned to Illinois prior to disposition.  (Section 7 of the Act)

 

f)         Upon the death of a person who had or is suspected of having an infectious or communicable disease or who was known to be a carrier or known to be sub-clinically infected with a disease that could be transmitted through contact with the person's body or bodily fluids, the body shall be labeled "Infectious Hazard", or with an equivalent term to inform persons having subsequent contact with the body, including any funeral director or embalmer.

 

1)         The label shall be prominently displayed on and affixed to the outer wrapping or covering of the body if the body is wrapped or covered in any manner.

 

2)         Responsibility for labeling shall lie with the attending physician or coroner who certifies death or, if the death occurs in a health care facility, with the staff member designated by the administrator of the facility.

 

3)         The person responsible for completion of the medical certification of cause of death shall record, on the death record, the presence of methicillin-resistant staphylococcus aureus, clostridium difficile, or vancomycin-resistant enterococci if the infection is a contributing factor to or the cause of death. (Section 18.1(c) of the Act)

 

g)         In every case in which a drug overdose is determined to be the cause of or a contributing factor in a death, the coroner or medical examiner shall report the death to the Department. When the cause of the overdose is available, the coroner or medical examiner shall report the cause of the overdose to the Department.

 

(Source:  Amended at 46 Ill. Reg. 20036, effective November 30, 2022)

 

Section 500.60  Court Order to Restore Original Certificate of Birth

 

a)         If a court of competent jurisdiction enters a decree or order in which it finds that it is in the best interest of a person for whom a new birth certificate has been established that his or her original birth certificate be restored, the State Registrar, upon receipt of a certified copy of such order or decree, shall restore the original Certificate of Live Birth to its place in the files, and the new certificate and evidence shall not be subject to inspection or certification, except upon order of a court of competent jurisdiction.

 

b)         The copies of the original birth certificate shall be returned by the State Registrar to the custodians of local records who shall replace them in their official file and surrender the copy of the newly prepared birth record to the State Registrar to be sealed from inspection.

 

(Source:  Amended at 15 Ill. Reg. 11706, effective August 1, 1991)

 

Section 500.70  Availability of Medical and Health Information

 

a)         All reports issued by the Department that are aggregated to make it impossible to identify any patient or reporting facility, including the annual report, shall be made available to the public pursuant to the Access to Records of the Department of Public Health (2 Ill. Adm. Code 1127) and the Freedom of Information Act [5 ILCS 140].

 

b)         All requests by bonafide researchers approved by the State Registrar seeking confidential vital records data and/or certificates must be submitted in writing to the Division of Vital Records.  The request must include a study protocol that contains: objectives of the research; rationale for the research, including scientific literature justifying the current proposal; overall study methods, including copies of forms, questionnaires, and consent forms used to contact facilities, physicians, or study subjects; methods for the processing of data; storage and security measures taken to insure confidentiality of the registrant and parental identifying information; time frame of the study; a description of the funding source of the study (e.g., federal contract); and the curriculum vitae of the principal investigator and a list of collaborators.  In addition, the research request must specify what identifying information is needed and how the information will be used.

 

c)         All requests to conduct research and all modifications to approved research proposals involving the use of data and/or vital records certificates that include identifying information shall be subject to a review to determine compliance with the following conditions:

 

1)         the request for identifying information contains stated goals or objectives;

 

2)         the request documents the feasibility of the study design in achieving the stated goals and objectives;

 

3)         the request documents the need for the requested data to achieve the stated goals and objectives;

 

4)         the requested data can be provided within the time frame set forth in the request;

 

5)         the request documents that the researcher has qualifications relevant to the type of research being conducted;

 

6)         the research will not duplicate other research already underway using the same data; and

 

7)         other conditions relevant to the need for the identifying information and the applicant's and parental confidentiality rights because the Department will only release identifying information that is necessary for the research.

 

d)         Research Agreements

 

1)         The Department will enter into research contracts for all approved research requests.  These contracts shall specify exactly what information is being released and how it can be used in accordance with the standards in subsection (c).  In addition, the researcher shall include an assurance that:

 

A)        use of data is restricted to the specifications of the protocol;

 

B)        any and all data and/or vital records certificates that may lead to the identity of any registrant or parent, research subject, physician, informant, other person, or hospital is strictly privileged and confidential, and the researcher agrees to keep all this data strictly confidential at all times;

 

C)        all officers, agents and employees will keep all this data strictly confidential, will communicate the requirements of this Section to all officers, agents, and employees, will discipline all persons who may violate the requirements of this Section, and will notify the Department in writing within 48 hours of any violation of this Section, including full details of the violation and corrective actions to be taken;

 

D)        all data provided by the Department pursuant to this contract may only be used for the purposes named in this contract and that any other or additional use of the data may result in immediate termination of this contract by the Department;

 

E)        all data provided by the Department pursuant to this contract is the sole property of the Department and may not be copied or reproduced in any form or manner, and the researcher agrees to return all data and all copies and reproduction of the data to the Department upon termination of this contract or make assurances that data and/or vital records certificates will be properly shredded or incinerated;

 

F)         any breach of any of the provisions of the research contract will void the contract.  All data previously provided by the Department, including any copies of the data, regardless of form, will be returned to the Department immediately.  No further data will be released to, nor research contracts entered into with, the principal investigator and collaborators for a period of time to be determined by the State Registrar.

 

2)         Any departures from the approved protocol must be submitted in writing and approved by the Director in accordance with subsection (c)(2) prior to initiation. No identifying information may be released by a researcher to a third party.

 

e)         In accordance with Jane Doe II v. Lumpkin, prior to the release to private researchers of any copies of birth records or data from the birth records that contain personal identifiers, the State shall first obtain informed consent from the mother to whom the record relates.  In requesting this informed consent, the mother shall be provided with a brief description of the research project.  Personal identifiers include names, social security numbers, addresses, or any combination of items that may divulge the identity of an individual listed on a Certificate of Live Birth.  For the purposes of this Part, private researchers shall include all those researchers who are not employed by the federal government and those researchers not employed by and/or not having a personal services contract to conduct the research utilizing the requested data with any State or local governmental body. Under a governmental personal services contract, the work product and all drafts of the contract shall remain the property of the State or local government.  Personal services contractors shall be considered custodians of vital records within the meaning of the Vital Records Act for the term of the personal services contract.

 

f)         Informed consent shall include the written signature of the mother approving her participation in the private research project.  Only after the Department receives informed consent from the mother approving the release of her medical data to the private researcher, may the Department release this data.

 

g)         The Department shall disclose individual patient or facility information to the reporting facility that originally supplied that information to the Department, upon written request of the facility.

 

h)         The patient identifying information submitted to the Department by those entities required to submit information under the Act and this Part is to be used in the course of medical study under Part 21 of Article 8 of the Code of Civil Procedure [735 ILCS 5/Art. 8, Part 21]. Therefore, this information is privileged from disclosure by Part 21 of Article 8 of the Code of Civil Procedure.

 

i)          The identity of any facility or any group of facts that tends to lead to the identity of any person submitted to the Division of Vital Records is confidential and shall not be open to public inspection or dissemination. This information shall not be available for disclosure, inspection, or copying under the Freedom of Information Act [5 ILCS 140] or the State Records Act [5 ILCS 160].  Information for specific research purposes may be released in accordance with procedures established by the Department in this Section.

 

j)          Every hospital shall provide representatives of the Department with access to information from all medical, pathological, and other pertinent records and logs related to the preparation of vital records.  The mode of access shall be by mutual agreement between the hospital and the Department.

 

k)         Notwithstanding the provisions of this Section, all information submitted to the Adoption Registry is confidential and gathered by the State solely for the purpose of facilitating the exchange of updated medical data and contact information between adopted and surrendered persons and other registered parties and shall not be released under this Section.  Disclosure of identifying information in violation of the Adoption Act is a Class A misdemeanor (Section 18.8 of the Adoption Act).

 

(Source:  Amended at 46 Ill. Reg. 20036, effective November 30, 2022)

 

Section 500.80  Appointment and Removal of Local Registrars

 

The State Registrar of Vital Records shall appoint and may remove for just cause local registrars.

 

a)         Persons eligible to serve as local registrars are:

 

1)         In cities, villages, and incorporated towns, the clerk of the city, village, or incorporated town.

 

2)         The township clerk in each township in counties under township organization, excepting those portions of the township constituting a separate registration district.

 

3)         The road district clerk in each road district in counties not under township organization, excepting those portions of the road district constituting a separate registration district.

 

4)         The health officer of any Public Health Department defined as a full time Public Health Department under the rules and regulations of the Department (see 77 Ill. Adm. Code 615).

 

5)         If none of the preceding officers is available to act as a local registrar, any full time public officer of county or local government in the district or a hospital administrator of any licensed hospital in the district which is not located within a home rule county (Section 7 of the Act).

 

b)         The State Registrar shall use the following criteria in appointing local registrars:  public convenience to the community and vital records preparers, filing efficiency in relation to the Vital Records Act, the best source available to preserve the integrity of the vital records, and any other similar vital records registration needs deemed essential by the State Registrar.

 

(Source:  Added at 15 Ill. Reg. 11706, effective August 1, 1991)

 

Section 500.90  Social Security Numbers of the Mother and Father of an Infant

 

a)         Effective November 1, 1990, the Social Security numbers of the mother and father shall be collected at the time of the birth of the child. Such numbers shall not be recorded on the Certificate of Live Birth.  Such numbers may be used only for those purposes allowed by federal law. (Section 11(d) of the Act).

 

b)         Under Section 125 of P.L. 100-485, states must collect the social security numbers of all parents of newborn infants, unless the state finds good cause for not requiring the number exists. "Good cause" for these purposes shall be limited to the following situations:

 

1)         Father unknown.

 

2)         The child was conceived as a result of sexual relations within families, criminal sexual assault or criminal sexual abuse.

 

3)         Parents/parent intends to release the child for adoption or legal proceedings for the adoption of the child are pending before a court of competent jurisdiction.

 

4)         Parents known, but one or both do not have social security numbers.

 

(Source:  Added at 15 Ill. Reg. 11706, effective August 1, 1991)

Section 500.APPENDIX A   Birth Records

 

Section 500.ILLUSTRATION A   Certificate of Live Birth

 

MATCHING DC

STATE OF ILLINOIS

CHILD'S BIRTH NUMBER

TYPE/PRINT IN

REGISTRATION

112-

PERMANENT

DISTRICT NO.

CERTIFICATE OF LIVE BIRTH

BLACK INK

REGISTERED

INSTRUCTIONS

NUMBER

SEE

CHILD'S NAME        FIRST             MIDDLE                 LAST

DATE OF BIRTH  (MONTH DAY YEAR)

TIME OF BIRTH

HANDBOOK

1.

2.

3.

M

CHILD

SEX

CHILD'S BLOOD TYPE

CITY, TOWN, TWP., ROAD DIST. NO. OR LOCATION OF BIRTH

COUNTY OF BIRTH

4.

5.

6.

7.

PLACE OF BIRTH

FACILITY NAME (IF NOT INSTITUTION, GIVE STREET AND  NUMBER

□ HOSPITAL

□  RESIDENCE

8.  OTHER (SPECIFY)

9.

I CERTIFY  THAT THIS CHILD WAS BORN ALIVE AT THE

DATE SIGNED  (MONTH,  DAY,   YEAR)

ATTENDANT'S NAME AND TITLE (IF OTHER THAN CERTIFIER)  (TYPE PRINT)

PLACE AND TIME AND ON THE DATE STATED:

10b

NAME

SIGNATURE

ILLINOIS LICENSE NUMBER

□    M.D.

□    D.O.

CERTIFIER ATTENDANT

10a. ►

10c

11.  OTHER (SPECIFY) ____________________________________________________

CERTIFIER'S NAME AND TITLE (TYPE PRINT)

ATTENDANTS MAILING ADDRESS (STREET AND NUMBER OR RURAL ROUTE NUMBER, CITY OR TOWN, STATE, ZIP CODE)

NAME  _________________________________________

□  M.D.

□  D.O

□  HOSPITAL ADMINISTRATOR

12.  OTHER (SPECIFY)  ___________________________________

13.

LOCAL REGISTRAR'S

DATE FILED BY LOCAL REGISTRAR      (MONTH,  DAY,  YEAR)

14.  SIGNATURE►

15.

MOTHER'S MAIDEN NAME      (FIRST,  MIDDLE,  LAST)

DATE OF BIRTH (MONTH ,  DAY ,   YEAR)

BIRTHPLACE (STATE OR FOREIGN COUNTRY)

16.

17.

18.

RESIDENCE-STREET AND NUMBER

CITY, TOWN, TWP., OR ROAD DIST. NO.

INSIDE CITY (YES  /  NO)

MOTHER

19a.

19b.

19c.

COUNTY

STATE

MOTHER'S MAILING ADDRESS (IF SAME AS RESIDENCE, ENTER ZIP CODE ONLY)

19d.

19e.

19f.

FATHER

FATHER'S NAME   (FIRST, MIDDLE, LAST)

DATE OF BIRTH (MONTH, DAY, YEAR)

BIRTHPLACE (STATE OR FOREIGN COUNTRY)

20.

21.

22.

INFORMANT

23.  I CERTIFY THAT THE PERSONAL INFORMATION PROVIDED ON THIS CERTIFICATE IS CORRECT TO THE BEST OF MY KNWOLEDGE AND BELIEF

23a.  MOTHER'S SIGNATURE ►

23b. FATHER'S SIGNATURE►

 

(Source:  Added at 15 Ill. Reg. 11706, effective August 1, 1991)

Section 500.APPENDIX A   Birth Records

 

Section 500.ILLUSTRATION B   Information for Medical and Health Use Only

 

 

VR100 REV 11/89

INFORMATION FOR MEDICAL AND HEALTH USE ONLY

(BASED ON 1989 U.S. STANDARD CERTIFICATE

OF HISPANIC ORGIN?

RACE-American Indian,

26. EDUCATION

27. OCCUPATION AND BUSINESS/INDUSTRY

(Specify No or Yes-If Yes

Black, White, etc.

(Specify only highest grade completed)

(Worked during last year)

specify Cuban, Mexican,

(Specify below)

Elementary/Secondary (0-12)

College (1-4 or 5+)

Occupation

Business/Industry

24.

Puerto Rican, etc.)

25.

No

Yes

MOTHER

24a.

Specify:

25a.

26a.

27a.

27b.

No

Yes

FATHER

24b.

Specify:

25b.

26b.

27c.

27d.

28.  PREGNANCY HISTORY (Complete each section)

MOTHER MARRIED? (at delivery, conception or at

DATE LAST NORMAL MENSES BEGAN

any time between) (Yes or No)

(Month, Day, Year)

29.

30.

LIVE BIRTHS (Do not include this child)

OTHER TERMINATIONS (Spontaneous and induced at any time after conception)

MONTH OF PREGNANCY PRENATAL CARE BEGAN

PRENATAL VISTS

First,   Second,   Third,   Etc.     (Specify)

Total Number (if none, so state)

31.

32.

NOW LIVING

NOW DEAD

BIRTHWEIGHT

CLINICAL ESTIMATE OF GESTATION

Number  ____

Number  ____

Number  _____

(Specify Units)

28a.    None

28b.    None

28d.     None

33.

34.

Weeks

DATE OF LAST LIVE BIRTH

DATE OF LAST OTHER TERMINATION

PLURALITY

IF NOT SINGLE BIRTH - Born

(Month, Year)

(Month, Year)

Single, Twin, Triplet, etc. (Specify)

First, Second, Third, etc.     (Specify)

28c.

28e.

35a.

35b.

36.  APGAR SCORE

MOTHER TRANSFERRED PRIOR TO DELIVERY?     No      Yes

IF YES, ENTER NAME AND LOCATION OF FACILITY TRANSFERRED FROM

37a.

1 MINUTE

5 MINUTES

INFANT TRANSFERRED?

No

Yes

IF YES, ENTER NAME AND LOCATION OF FACILITY TRANSFERRED TO

36a.

36b.

37b.

38a.

MEDICAL RISK FACTORS FOR THIS PREGNANCY (Check all that apply)

40.

COMPLICATIONS OF LABOR AND/OR DELIVERY (Check all that apply)

43.

CONGENITAL ANOMALIES OF CHILD (Check all that apply)

Anemia (Hct.<30/Hgb. <10)................................................

01

Febrile (>100°F. or 38°C.)

01

Anencephalus

01

Cardiac disease...............................................

02

Meconium, moderate, heavy

02

Spina bifida/Meningocele

02

Acute or chronic lung disease...........................................

03

Premature rupture of membrane (>12 hours)

03

Hydrocephalus..............................................................

03

Diabetes

04

Abruptio placenta

04

Microcephalus

04

Genital herpes..................................................................

05

Placenta previa

05

Other central nervous system anomalies

Hydramnios/Oligohydramnios..........................

06

Other excessive bleeding

06

(Specify) ___________________________

05

Hemoglobinopathy......................................................

07

Seizures during labor

07

Heart malformations

06

Hypertension, chronic.....................................

08

Precipitous labor (<3 hours)

08

Other circulatory/respiratory anomalies

Hypertension, pregnancy associated................................

09

Prolonged labor (>20 hours)

09

(Specify) ___________________________

07

Eclampsia.........................................................

10

Dysfunctional labor

10

Rectal atresia/stenosis

08

Incompetent cervix..........................................................

11

Breech/Malpresentation

11

Tracheo-esophageal fistula/

Previous infant 4000 + grams.............................

12

Cephalopelvic disproportion

12

Esophageal atresia..............................................................

09

Previous preterm or small-for-gestational-age infant............

13

Cord prolapse

13

Omphalocele/gastroschisis

10

Renal disease...................................................

14

Anesthetic complications

14

Other gastrointestinal anomalies

Rh sensitization...............................................................

15

Fetal Distress

15

(Specify) ___________________________

11

Uterine bleeding................................................

16

None

00

Malformed genitalia

12

None...............................................................................

00

Other (specify)_______________________________

16

Renal agenesis..............................................................

13

Other (specify) ________________________

17

Other urogenital anomalies

41.  METHOD OF DELIVERY (Check all that apply)

(Specify) __________________

14

38b.  OTHER RISK FACTORS FOR THIS

Vaginal

01

Cleft lip palate..............................................................

15

PREGNANCY (Complete all items)

Vaginal birth after previous C-section

02

Polydactyly/syndactyly/Adactyly

16

Tobacco use during pregnancy..........................

Yes

No

Primary C-section

03

Club foot..............................................................

17

Average number of cigarettes per day ___

Repeat C-section

04

Diaphragmatic hernia

18

Alcohol use during pregnancy............................

Yes

No

Forceps

05

Other musculoskeletal/integumental anomalies

Average number drinks per week _____

Vacuum

06

(Specify) ___________________________

19

Weight gain during pregnancy _____ lbs.

42.  ABNORMAL CONDITIONS OF THE

Down's syndrome

20

NEWBORN (Check all that apply)

Other chromosomal anomalies

39.  OBSTETRIC PROCEDURES

Anemia (Hct.<39/Hgb. <13)

01

(Specify) ___________________________

21

(Check all that apply)

Birth injury

02

None

00

Amniocentesis................................................................

01

Fetal alcohol syndrome

03

Other (specify)  ______________________

22

Electronic fetal monitoring.................................

02

Hyaline membrane disease/RDS

04

44a.  DATE OF MOTHER'S BLOOD TEST FOR SYPHILIS

Induction of labor.............................................................

03

Meconium aspiration syndrome

05

(MONTH, DAY, YEAR)

Stimulation of labor...........................................

04

Assisted ventilation <30 min.

06

Tocolysis........................................................................

05

Assisted ventilation ≥30 min.

07

Ultrasound........................................................

06

Seizures

08

44b.  LABORATORY DOING THE SEROLOGY

None...............................................................................

00

None

00

Other (specify) ________________________

07

Other (Specify) ____________________

09

MOTHER

Social Security Number

FATHER

Social Security Number

45.

46.

 

 

(Source:  Added at 15 Ill. Reg. 11706, effective August 1, 1991)

 

Section 500.APPENDIX A   Birth Records

 

Section 500.ILLUSTRATION C   Record of a Foreign Birth

 

STATE OF ILLINOIS   RECORD OF A FOREIGN BIRTH

(ORIGINAL) STATE FILE NO. Z –

 

1.  PLACE OF BIRTH:

(CITY)

(COUNTRY)

2.  NAME OF CHILD:

3.  DATE OF BIRTH:

(MONTH)

(DAY)

(YEAR)

4.  SEX

5.  FATHER'S FULL NAME:

6.  FATHER'S BIRTH DATE:

(MONTH)

(DAY)

(YEAR)

7.  FATHER'S BIRTHPLACE:

(CITY OR COUNTY)

(STATE OR COUNTRY)

8.  MOTHER'S MAIDEN NAME:

9.  MOTHER'S BIRTH DATE:

(MONTH)

(DAY)

(YEAR)

10.  MOTHER'S        BIRTHPLACE:

(CITY OR COUNTY)

(STATE OR COUNTRY)

OFFICE OF VITAL RECORDS – ILLINOIS DEPARTMENT OF PUBLIC HEALTH – SPRINGFIELD 62761

I HEREBY CERTIFY that this record is the original certificate of birth as established under the provisions of the Illinois Vital Records Act.

Date Filed

State Registrar

Springfield, Illinois

By ________________________________________

Deputy State Registrar

KIND OF DOCUMENT AND DATE MADE

BIRTH FACTS ESTABLISHED

VR-162Z  (8/71r)

 

(Source:  Added at 15 Ill. Reg. 11706, effective August 1, 1991)

Section 500.APPENDIX A   Birth Records

 

Section 500.ILLUSTRATION D   Certificate of Birth – Foundling Child

 

 

 

 

 

 

 

STATE OF ILLINOIS

 

CERTIFICATE OF BIRTH – FOUNDLING CHILD

 

 

 

File No.  ______________________

 

NAME GIVEN CHILD BY CUSTODIAN:
PLACE CHILD WAS FOUND:	(CITY, VILLAGE, TOWNSHIP OR ROAD DISTRICT)							(COUNTY)
DATE CHILD WAS FOUND:	(MONTH)	(DAY)	(YEAR)	SEX	RACE	APPROXIMATED AGE:
NAME OF CUSTODIAN:	(PERSON OR INSTITUTION)
MAILING ADDRESS OF CUSTODIAN:
CHILD FOUND BY:
MAILING ADDRESS OF FINDER:
REPORTED TO REGISTRAR ON:	(SIGNED)						LOCAL REGISTRAR

 

ILLINOIS DEPARTMENT OF PUBLIC HEALTH – DIVISION OF VITAL RECORDS

 

 

VR 102 (2/79)

 

(Source:  Added at 15 Ill. Reg. 11706, effective August 1, 1991)

Section 500.APPENDIX A   Birth Records

 

Section 500.ILLUSTRATION E   Application for Search of Birth Record Files

 

 

 

APPLICATION FOR SEARCH OF BIRTH RECORD FILES

The fee for a search of the files is $10.00.  If the record is found one CERTIFICATION or BIRTH CARD is issued at no additional charge.  Additional certifications or birth cards of the same record ordered at the same time are $2.00 each.  The fee for a FULL CERTIFIED COPY is $15.00.  Additional certified copies of the same record ordered at the same time are $2.00 each.  Please indicate below the type and number of copies requested and return this form with the proper fee.  DO NOT SEND CASH.  Make check or money order payable to:  Illinois Department of  Public Health.

CERTIFIED COPY

CERTIFICATION

BIRTH CARD   (wallet size)

$15.00 Each

$10.00 Each

$10.00  Each

Amount Enclosed:

$

Amount Enclosed:

$

Amount Enclosed:

$

for

copies

for

copies

for

copies

First

Middle

Last

FULL NAME:

PLACE OF BIRTH:

Street, RFD., Hosp.

City or Town

County

DATE OF BIRTH:

Month

Day

Year

SEX:

BIRTH NUMBER IF KNOWN:

FATHER:

MOTHER:

Maiden Name

Married Name

 

Application Made By:						Mail Copy to (if other than applicant):
NAME:						NAME:
	(written signature)
STREET						STREET
ADDRESS:						ADDRESS:
CITY:		STATE:	ZIP			CITY		STATE:	ZIP
YOUR RELATIONSHIP TO PERSON:						INTENDED USE OF DOCUMENT:

 

NOTE:  Birth certificates are confidential records, and copies can be issued only to persons entitled to receive them.  The application must indicate the requestor's relationship to the person and the intended use of the document.  (SEE OTHER SIDE)

 

 

 

VR.  180 (5/87R)-DIVISION OF VITAL RECORDS-605 WEST JEFFERSON STREET-ILLINOIS DEPARTMENT OF PUBLIC HEALTH, SPRINGFIELD, ILLINOIS  62702

 

(Source:  Added at 15 Ill. Reg. 11706, effective August 1, 1991)

Section 500.APPENDIX A   Birth Records

 

Section 500.ILLUSTRATION F   Application for Correction of a Birth Certificate

 

APPLICATION FOR CORRECTION OF A BIRTH CERTIFICATE

 

MAIL TO:          Illinois Department of Public Health

Office of Vital Records

605 West Jefferson

Springfield, Illinois  62761

 

I wish to have errors corrected on the birth certificate identified as follows:

 

FULL NAME

OF CHILD:

PLACE

OF BIRTH:

HOSPITAL

COUNTY

CITY, VILLAGE, TOWNSHIP

DATE

REGISTERED

STATE FILE

OF BIRTH:

NUMBER

NUMBER

MONTH           DAY           YEAR

MOTHER'S

MAIDEN NAME:

FATHER'S NAME AS

LISTED ON BIRTH RECORD:

Please give us the INCORRECT and CORRECT information below:

INCORRECT INFORMATION

CORRECT INFORMATION

SHOULD READ

PRINT

PRINT

SHOULD READ

PRINT

PRINT

SHOULD READ

PRINT

PRINT

SHOULD READ

PRINT

PRINT

SHOULD READ

PRINT

PRINT

ADDITIONAL COMMENTS:

Please mail correction forms to:

WRITTEN SIGNATURE:

ADDRESS:

DATE:

MY RELATIONSHIP TO CHILD:

VR – 401.1  REV. 6/75

 

(Source:  Added at 15 Ill. Reg. 11706, effective August 1, 1991)

Section 500.APPENDIX B   Delayed Birth Records

 

Section 500.ILLUSTRATION A   Instructions for Filing a Delayed Record of Birth for a Child Age One to Seven Years

 

 

Division of Vital Records

605 West Jefferson Street

Springfield, Illinois 62702

Telephone (217)782-6553

 

INSTRUCTIONS FOR FILING A DELAYED RECORD OF BIRTH

FOR A CHILD AGE ONE TO SEVEN YEARS

 

Under the provisions of Paragraph 73-14 of the Vital Records

(Illinois Revised Statutes 1989, Chapter 111½ Paragraphs, 73-1 - 73-29)

 

WHOSE BIRTH MAY BE RECORDED?  Any living child, who was born in Illinois more than one year but less than seven years ago, whose birth was not recorded before.  The birth facts must be proved by documents.  See other side of this page.  (to Record the birth of anyone over age seven, write for instructions.)

 

WHO MAY APPLY?  The child's parent, legal guardian, or other legal representative.

 

HOW TO FILL IN THE DELAYED RECORD OF BIRTH (Form VR 141A).  Enter the correct information at items #1 through #8.  The affidavit portion (item #9) requires the notarized, personal pen-and-ink signature of the parent, legal guardian, or other legal representative, and address.  (A married woman should sign her given names and legal surname.)  The notary public must complete his certification, and affix his signature and seal.

 

(Illegitimate births:  If the mother was not married to the father of the child either at the time of conception or birth, the name of the father shall not be entered on the certificate of birth without the written consent of the mother and the person to be named as the father; unless a determination of paternity has been made by a court of competent jurisdiction, in which case a certified copy of the court order shall be submitted.  The written consent can be furnished by separate statements by the mother and father, or by having both of them sign at item #9 of the Delayed Record.)

 

IMPORTANT!  Remember, the birth record is an important permanent legal paper; it must be clearly readable.  Signatures must be written (not printed) in a permanent black ink.  All other entries, should be typewritten in black ink or hand-printed clearly with black ink.  Strike-overs and erasures should be avoided.

 

Illinois law requires that each request to file a Delayed Record of Birth shall be accompanied by a fee of $10.00.  This fee entitles the applicant to one certified copy of the Delayed Record of Birth when accepted for filing. Each additional copy is $2.00 when ordered at the same time.  Make check or money order payable to the Illinois Department of Public Health.

 

Page 2

 

INSTRUCTIONS FOR FILING A DELAYED RECORD OF BIRTH

FOR A CHILD AGE ONE TO SEVEN YEARS--(Cont'd)

 

SELECTING DOCUMENTS TO PROVE THE BIRTH FACTS

 

•    The birth facts below, as entered on the Delayed Record of Birth, must be proven at least once:

 

Place of birth.              Father's full name.

Date of birth.               Mother's full maiden name.

 

•    It may take more than one document to prove the birth facts.

 

•    Documents created at or nearest the time of birth make the best proof, and the best birth record.

 

•    There must be no unexplained alterations on the documents submitted as proof.

 

•    Either the original document, a certified photograph or copy of the original document, or a certified statement of the facts about the birth that appear in the document, may be used.

 

•    The document must show when and with what agency or official the information was originally recorded, including any particular identifying file number, and the complete address of such agency or official.

 

SUGGESTED DOCUMENTS

 

HOSPITAL'S RECORD OF THE DELIVERY (if child was born in a hospital) – obtain from the hospital.

 

ATTENDING PHYSICIAN'S OR MIDWIFE'S RECORD OF THE DELIVERY – obtain from the physician, midwife, or present custodian of their records.

 

BAPTISMAL, CRADLE ROLL, OR OTHER CHURCH RECORD – obtain from the pastor or other person who now has the church records.

 

BIRTH ANNOUNCEMENT – submit one which was sent to a relative or friend.

 

COPY OF LIFE INSURANCE APPLICATION – obtain from the insurance company.

 

FAMILY BIBLE RECORD – submit only if entry is dated and was made at or near the time of the birth.  Name and address of the present custodian of the Bible must be furnished.

 

HOSPITAL ADMISSION RECORD (if the child was ever a patient in a hospital since birth) – obtain from the hospital.

 

SCHOOL ENROLLMENT OR SCHOOL CENSUS RECORD – obtain from the county superintendent of schools or the city board of education where the child entered school.  (If the child first entered school in the City of Chicago, write the Chicago Board of Education, 228 North LaSalle Street, Chicago, Illinois 60601.)

 

FEDERAL CENSUS REPORT (if census was taken since the child's birth) – available from the U.S. Department of Commerce, Bureau of the Census, Pittsburgh, Kansas 66762.  Application blanks may be obtained from the county clerk or the Illinois Department of Public Health.

 

(Source:  Added at 15 Ill. Reg. 11706, effective August 1, 1991)

 

Section 500.APPENDIX B   Delayed Birth Records

 

Section 500.ILLUSTRATION B   Delayed Record of Birth

 

VR-141A (1978)

Type or Print in PERMANENT INK

REGISTRATION DISTRICT NO

DELAYED RECORD OF BIRTH

CHILD'S BIRTH NUMBER

(AGE 12 MONTHS TO 7 YEARS)

112-

THIS IS A PERMANENT RECORD • USE TYPEWRITER WITH BLACK RIBBON OR PRINT WITH PEN USING BLACK INK • ALL SIGNATURES MUST BE HAND WRITTEN IN PEN AND INK THIS DELAYED RECORD OF BIRTH MUST BE EXECUTED IN ACCORDANCE WITH THE PROVISIONS OF PARAGRAPH 73–14 OF THE VITAL RECORDS ACT

CHILD – NAME

FIRST

MIDDLE

LAST

DATE OF BIRTH (MONTH DAY YEAR)

1.

2a.

HOUR

SEX

HOSPITAL - NAME

(IF NOT IN HOSPITAL, GIVE STREET AND NUMBER)

CHILD

2b.

M.

3.

4a.

CITY, TOWN, TWP. OR ROAD DISTRICT NO.

COUNTY

4b.

4c.

MOTHER – MAIDEN NAME

FIRST

MIDDLE

LAST

AGE (AT TIME OF THIS BIRTH)

STATE OF BIRTH (IF NOT IN U.S.A.  NAME COUNTRY)

5a.

5b.

5c.

MOTHER

RESIDENCE

STREET AND NUMBER

CITY, TOWN, TWP. OR ROAD DISTRICT NO

INSIDE CITY (YES/NO)

COUNTY

STATE

6a.

6b.

6c.

6d.

6e.

MOTHER'S COMPLETE MAILING ADDRESS

STREET AND NUMBER OR R.F.D.

CITY OR TOWN

STATE

ZIP

7.

FATHER

FATHER –  NAME

FIRST

MIDDLE

LAST

AGE (AT TIME OF THIS BIRTH)

STATE OF BIRTH (IF NOT IN U.S.A.  NAME COUNTRY)

8a.

8b.

8c.

THIS RECORD SHALL BE PRESENTED FOR FILING TO THE STATE REGISTRAR OF VITAL RECORDS AT SPRINGFIELD.   WHEN ACCEPTED AND FILED AN EXACT COPY WILL BE FURNISHED THE COUNTY CLERK OF THE COUNTY IN WHICH THE BIRITH OCCURRED.

9. AFFIDAVIT:  I HEREBY DECLARE UPON OATH THAT THE ABOVE STATEMENTS ARE TRUE TO THE BEST OF MY KNOWLEDGE AND BELIEF.

a.) SIGNED:

b.) ADDRESS

(PARENT – LEGAL GUARDIAN)

(SEAL)

c.) SUBSCRIBED AND SWORN TO BEFORE ME THIS

DAY OF

,

19

AT

(PLACE)

COUNTY CLERK OR NOTARY PUBLIC

APPLICANT!  DO NOT WRITE BELOW THIS LINE

KIND OF DOCUMENT AND DATE MADE

INFORMATION GIVEN IN DOCUMENT AS TO BIRTH DATE, BIRTHPLACE, AND PARENTS

ABSTRACT OF SUPPORTING EVIDENCE

DOCUMENT NO. 1

AGE OR BIRTH DATE:

BIRTHPLACE:

FATHER:

MOTHER:

DOCUMENT NO. 2

AGE OR BIRTH DATE:

BIRTHPLACE:

FATHER:

MOTHER:

DOCUMENT NO. 3

AGE OR BIRTH DATE:

BIRTHPLACE:

FATHER:

MOTHER:

DOCUMENT NO. 4

AGE OR BIRTH DATE:

BIRTHPLACE:

FATHER:

MOTHER:

ACCEPTED AND FILED AT SPRINGFIELD FOR THE STATE REGISTRAR OF VITAL RECORDS

BY

,

DEPUTY STATE REGISTRAR, ON

,

19

THIS RECORD IS VALID ONLY IF IT HAS BEEN ACCEPTED BY AND FILED WITH THE STATE REGISTRAR OF VITAL RECORDS AT SPRINGFIELD, ILLINOIS

OFFICE OF VITAL RECORDS – ILLINOIS DEPARTMENT OF PUBLIC HEALTH – SPRINGFIELD 62761

 

Section 500.APPENDIX B   Delayed Birth Records

 

Section 500.ILLUSTRATION C   Filing a Delayed Record of Birth After the Seventh Birthday)

 

FILING A DELAYED RECORD OF BIRTH AFTER THE SEVENTH BIRTHDAY

 

These instructions apply only to, a living person, born in Illinois, whose birth record is not on file, and who has passed his or her 7^th birthday.

 

PLEASE FOLLOW THE INSTRUCTIONS CAREFULLY

 

BIRTH PRIOR TO JANUARY 1, 1916 – Secure a written statement from the County Clerk that the birth is not on file.  A space for this statement is provided on the Birth Record form.  Proceed with the instructions below.

 

BIRTHS AFTER JANUARY 1, 1916 – Proceed with the instructions below.

 

IN ORDER TO ESTABLISH A DELAYED RECORD OF BIRTH

 

1.        Complete through line 7 on the Delayed Record of Birth Application – FORM VR 141.

 

2.        Sign and have notarized Line 8.  (See example below)

 

3.        If either of your parents are living, have one of them complete Form C, sign it, and have it notarized.  If not, have a brother, sister, aunt, uncle, or friend who has known you for at least 25 years, complete Form D, sign it and have it notarized.

 

4.        In addition to submitting the forms mentioned in item 3, you must submit one or more documents, created at least 5 years ago that prove your birthdate and birthplace.  Suggested documents are listed on the back of this sheet.

 

5.        The statutory fee for filing a Delayed Record of Birth is $15.00.  This fee entitles you to one certified copy of the birth record after it is accepted for filing by this office.

 

Application must be signed before a Notary Public.  The Notary will then complete the form with the date signed, his address, signature and raised seal.  If you do not know where to find a Notary Public, contact your bank, or check the yellow pages of your telephone directory.

 

STATE OF ILLINOIS

DELAYED RECORD OF BIRTH

ORIGINAL

DEPARTMENT OF PUBLIC HEALTH

STATE FILE NO.

(REGISTERED AFTER SEVENTH BIRTHDAY)

CHILD-NAME

FIRST

MIDDLE

LAST

DATE OF BIRTH (MONTH, DAY, YEAR)

1.

Mary

Jane

Smith

2.

July 4, 1875

If your name has been changed (except by marriage) enter the name you are now known by in this space.

SEX

3.

Mary Ellen Smith

4.

Female

CITY, TOWN, TWP. OR ROAD DISTRICT NO.

COUNTY

5a.

Chicago

5b.

Cook

MOTHER- MAIDEN NAME

FIRST

MIDDLE

LAST

AGE (AT TIME OF THIS BIRTH)

STATE OF BIRTH (IF NOT IN U.S.A. NAME  COUNTRY)

6a.

Betty

Lou

Brown

6b.

22

6c.

Illinois

FATHER - NAME

FIRST

MIDDLE

LAST

AGE (AT TIME OF THIS BIRTH)

STATE OF BIRTH (IF NOT IN U.S.A. NAME  COUNTRY)

7a.

James

Smith

7b.

23

7c.

Germany

8.

AFFIDAVIT:  I hereby declare upon oath that the above statements are true to the best of my knowledge and belief.

a.)  Signed

Mary Ellen Jones

b.)  Address

222 Fast Corner Street

(PRESENT LEGAL NAME OF REGISTRANT)

Chicago, Illinois 60000

(SEAL)

c.)  Submitted and sworn to before me this

2nd

day of

February

19

64

at

Chicago, Illinois

John Doe

(PLACE)

SIGNATURE OF COUNTY CLERK OR NOTARY

APPLICANT!  DO NOT WRITE BELOW THIS LINE

VR 154 (Rev.2/84)

 

SUGGESTED DOCUMENTS

(to prove date & place of birth – at least 5 years old)

 

HOSPITAL'S RECORD OF THE DELIVERY – Obtain from hospital of birth.

 

ATTENDING PHYSICIAN'S OR LICENSED MIDWIFE'S RECORD OF THE DELIVERY – Obtain from the physician, midwife, or present custodian of their records.

 

BAPTISMAL, CRADLE ROLL, OR OTHER CHURCH RECORD – Obtain from the present custodian of the church records, showing name and location of church, baptismal date and birth facts.

 

BIRTH ANNOUNCEMENT – Submit one which was sent to a relative or friend, showing the date it was mailed.

 

COPY OF LIFE INSURANCE OR BURIAL INSURANCE APPLICATION – Obtain from the insurance company showing name and address of company, policy number, date of issuance and birth facts.

 

FAMILY BIBLE RECORD – Submit only if entry is dated and was made at or near the time of birth. Give name and address of present custodian of the Bible.

 

HOSPITAL OR CLINIC ADMISSION RECORD – Obtain statement from hospital or clinic, showing location, date of admission, and applicant's birth facts.

 

SCHOOL ENROLLMENT OR SCHOOL CENSUS RECORD – Obtain from the county superintendent of schools or the city board of education where person entered school. (If in Chicago, write to the Chicago Board of Education, 228 North LaSalle, Chicago, Illinois 60601).

 

FEDERAL CENSUS REPORT – (preferably the first census taken after the person's birth) Obtain from Department of Commerce, Bureau of the Census, Pittsburg, Kansas  66762. Obtain blanks from county clerk or the Illinois Department of Public Health.

 

MARRIAGE RECORD – Secure a certified copy of the marriage license application and return (NOT the marriage certificate itself) from the county clerk of the county where the license was obtained.  (Information not on Cook County marriages).

 

VOTING REGISTRATION – By the present election commission of the area (NOT YOUR CARD).

 

SOCIAL SECURITY – Photocopy of APPLICATION for Social Security number – available FREE from the Social Security Administration, Baltimore, Maryland (NOT YOUR CARD).

 

MILITARY RECORD – From any branch of the United States Armed Services.

 

BIRTH CERTIFICATE OF A CHILD OF THE PERSON WHOSE BIRTH IS NOW BEING REGISTERED – Furnish names of children, and dates and places of birth, if born in Illinois after 1915: otherwise, FULL certified copy issued by official custodian of record.

 

ONLY ONE NOTARIZED AFFIDAVIT – may be accepted as one proof of the birth facts, when sufficient documents are not available to prove the birth facts as outlined above. The affidavit may be made by a relative, or a friend of 25 years, familiar with the birth facts. The person making the affidavit should sign IN INK his or her first and present last name and present address, BEFORE A NOTARY PUBLIC.

 

Submit the documents and completed record to:

 

Illinois Department of Public Health

Division of Vital Records

535 West Jefferson Street

Springfield, IL.  62761

 

(Source:  Added at 15 Ill. Reg. 11706, effective August 1, 1991)

Section 500.APPENDIX B   Delayed Birth Records

 

Section 500.ILLUSTRATION D   Application for Delayed Record of Birth

 

APPLICATION FOR DELAYED RECORD OF BIRTH

Full Name

of Child

Date

Time

Sex

of Birth

of Birth

of Child

Place

of Birth

Hospital

County

City, Village, Township

If not born in hospital, give complete address where child was born

Mother's

Maiden Name

Mother's

Mother's

Date of Birth

Place of Birth

Mother's complete mailing

address at time of child's birth

Street & number or R.F.D.

City or Town

State

Zip

Mother's residence at

time of child's birth

Street & number

City or Town

Yes/No

Inside City

County

State

Father's

Full Name

Father's

Father's

Date of Birth

Place of Birth

Was mother married at the time of conception, birth or anytime between conception and birth?  If yes, date of parent's marriage

List below all OTHER children of this mother who were born BEFORE this child was born.  DO NOT COUNT THIS CHILD

(a)

Number

(b)

Number BORN alive

(c)

Number

still living

but now dead

born dead

Written Signature

Address

My Relationship to Child

8631A

 

(Source:  Added at 15 Ill. Reg. 11706, effective August 1, 1991)

Section 500.APPENDIX B   Delayed Birth Records

 

Section 500.ILLUSTRATION E   Delayed Record of Birth (Registered After Seventh Birthday)

 

THIS IS A PERMAMENT RECORD •USE TYPEWRITER WITH BLACK RIBBON OR PRINT WITH PEN USING BLACK INK •ALL SIGNATURES MUST BE HANDWRITTEN IN PEN AND INK This Delayed Record of Birth must be executed in accordance with the provisions of Paragraph 73-14 of the Vital Records Act (Paragraphs 73-1 through 73-29, Chapter 111 ½, Illinois Revised Statutes, as amended) and with the rules and instructions of the                                                          Illinois Department of Public Health.                                                                   This record shall be presented for filing to the State Registrar of Vital Records at Springfield. When accepted and filed an exact copy will be furnished the county clerk of the county in which the birth occurred. I certify that a diligent search of the official birth records was made and that no prior certificate was found for this registrant.

I certify that a diligent search of the official birth records was made and that no prior certificate was found for this registrant.   Signed ____________________________________________________                                    Date _______________________________                                                                                                                                                                                                                                                                                                                                                                  Title______________________________________________________

STATE OF ILLINOIS DEPARTMENT OF PUBLIC HEALTH

ORIGINAL

DELAYED RECORD OF BIRTH

STATE FILE NO.

(REGISTERED AFTER SEVENTH BIRTHDAY)

CHILD-NAME

FIRST

MIDDLE

LAST

DATE OF BIRTH (MONTH, DAY, YEAR)

1.

2.

If your name has been changed (except by marriage) enter the name you are now known by in this space.

SEX

3.

4.

CITY, TOWN, TWP, OR ROAD DISTRICT NO.

COUNTY

5a.

5b.

MOTHER-MAIDEN NAME

FIRST

MIDDLE

LAST

AGE (AT TIME OF THIS BIRTH)

STATE OF BIRTH (IF NOT IN U.S.A. NAME COUNTRY)

6a.

6b.

6c.

FATHER-NAME

FIRST

MIDDLE

LAST

AGE (AT TIME OF THIS BIRTH)

STATE OF BIRTH (IF NOT IN U.S.A. NAME COUNTRY)

7a.

7b.

7c.

8. AFFIDAVIT:  I hereby declare upon oath that the above statements are true to the best of my knowledge and belief.

b.)

Address

a.) Signed

(PRESENT LEGAL NAME OF REGISTRANT)

(SEAL)

c)

Subscribed and sworn to before me this

day of

19

at

(PLACE)

SIGNATURE OF COUNTY CLERK OR NOTARY

APPLICANT! DO NOT WRITE BELOW THIS LINE

KIND OF DOCUMENT AND DATE MADE

INFORMATION GIVEN IN DOCUMENT AS TO BIRTH DATE, BIRTHPLACE, AND PARENTS

ASBSTRACT OF SUPPORTING EVIDENCE

DOCUMENT No. 1

Age or birth date:

Birthplace:

Father:

Mother:

DOCUMENT No. 2

Age or birth date:

Birthplace:

Father:

Mother:

DOCUMENT No. 3

Age or birth date:

Birthplace:

Father:

Mother:

DOCUMENT No. 4

Age or birth date:

Birthplace:

Father:

Mother:

ACCEPTED AND FILED AT SPRINGFIELD FOR THE STATE REGISTRAR OF VITAL RECORDS

by

Deputy State Registrar, on

,

19

This record is valid only if it has been accepted by and filed with the State Registrar of Vital Records at Springfield, Illinois.

ILLINOIS DEPARTMENT OF PUBLIC HEALTH – OFFICE OF VITAL RECORDS

 

(Source:  Added at 15 Ill. Reg. 11706, effective August 1, 1991)

Section 500.APPENDIX B   Delayed Birth Records

 

Section 500.ILLUSTRATION F   Affidavit in Support of an Application for a Delayed Registration of Birth (Continued)

 

FORM C – AFFIDAVIT OF PARENT FOR A DELAYED REGISTRATION OF THE BIRTH OF

ON

Name

Month

Day

Year

AT

ILLINOIS

City and County

STATE OF

}

COUNTY OF

I,

, of lawful age, being

duly sworn upon oath, depose and say:

THAT I am the

of the person named above and that this child was born on

Father, Mother

at

Month

Day

Year

Street address or general location in the community

in

,

County, Illinois;

City, village, township or road district

AND FURTHER THAT the personal particulars of the child's parents are as follows:

Father's full name is

his color or race is

the year of his

birth was

and his birthplace was

City or county and state or country

Mother's MAIDEN name is

her color or race is

the year of her

birth was

and her birthplace was

City or county and state or country

AND FURTHER THAT this was a

birth and that this child was the

Single, twin, triplet

1st, 2nd, 3rd, 4th, etc.

child born alive to this mother and that the following children were born to her on or before the birthdate of this child at the places and dates stated:

NAME

SEX

DATE OF BIRTH

BIRTHPLACE

(month, day, year)

(city or county & state or country)

was

1)

,

male,

born

at

was

2)

,

male,

born

at

was

3)

,

male,

born

at

was

4)

,

male,

born

at

was

5)

,

male,

born

at

was

6)

,

male,

born

at

Signed

Address:

Subscribed and sworn to before me this

day of

19

at

Notary Public in and for the State of

(SEAL)

Address:

VR-154C

FORM FURNISHED BY THE DEPARTMENT OF VITAL RECORDS, ILLINOIS DEPARTMENT OF PUBLIC HEALTH

 

(Source:  Added at 15 Ill. Reg. 11706, effective August 1, 1991)