Illinois Administrative Code › Title 77 - PUBLIC HEALTH › Part 500 - ILLINOIS VITAL RECORDS CODE › Appendix B - Delayed irth Records › ILLUSTRATION C - Filing a Delayed Record of Birth After the Seventh Birthday

Current through Register Vol. 48, No. 28, July 12, 2024
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
				  7th 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.
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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