Ill. Admin. Code tit. 77, pt. 500, app E, ILLUSTRATION G
Current through Register Vol. 48, No. 49, December 6, 2024
________________________________ (signature of adopted person) | ||||||||||||||||||||||||||
______________________________ (date) | ______________________________ (printed or typed name of adopted person) | |||||||||||||||||||||||||
Illinois Department of Public Health, Division of Vital Records, 605 W. Jefferson St., Springfield, IL 62702-5097.
VR 161.2 (rev. 05/2000)Printed by Authority of the State of Illinois P.O. # 30M O2/00
Ill. Admin. Code tit. 77, pt. 500, app E, ILLUSTRATION G