Illinois Administrative Code (Last Updated: March 27, 2024) |
TITLE77. PUBLIC HEALTH |
PART500. ILLINOIS VITAL RECORDS CODE |
Section500.APPENDIX E. Adoption Records |
§500.ILLUSTRATION O. Adoption Registry Application Form
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Illinois Department of Public Health
ILLINOIS ADOPTION REGISTRY APPLICATION
(Enter all known information.)
Illinois Department of Public Health
ILLINOIS ADOPTION REGISTRY APPLICATION
Section C – Optional written statement
This optional written statement is authorized for release as specified in Section C of the Adoption Registry Application. This statement is limited to the space (two pages) provided on this form and cannot include information that would identify any person other than the registrant submitting the statement. This written statement will be reviewed by registry staff to verify compliance with the law. Registry staff must remove prohibited identifying information or return the statement to the registrant for compliance. Please type, write clearly or print in dark blue or black ink. A lined and unlined page are provided for your convenience. Both pages may be used.
Illinois Department of Public Health, Division of Vital Records, 605 W. Jefferson St., Springfield, IL 62702-5097
Illinois Department of Public Health
ILLINOIS ADOPTION REGISTRY APPLICATION
Section C – Optional written statement
This optional written statement is authorized for release as specified in Section C of the Adoption Registry Application. This statement is limited to the space (two pages) provided on this form and cannot include information that would identify any person other than the registrant submitting the statement. This written statement will be reviewed by registry staff to verify compliance with the law. Registry staff must remove prohibited identifying information or return the statement to the registrant for compliance. Please type, write clearly or print in dark blue or black ink. A lined and unlined page are provided for your convenience. Both pages may be used.
Illinois Department of Public Health, Division of Vital Records, 605 W. Jefferson St., Springfield, IL 62702-5097
(Source: Amended at 24 Ill. Reg. 11882, effective July 26, 2000)