Ill. Admin. Code tit. 77, pt. 500, app E, ILLUSTRATION M
Current through Register Vol. 49, No. 2, January 10, 2025
_______________________________ | |||
(signature of adoptive parent) | |||
___________________________ | ________________________________ | ||
(date) | (printed or typed name of adoptive parent) | ||
Illinois Department of Public Health, Division of Vital Records, 605 W. Jefferson St., Springfield IL 62702-5097 | |||
VR 161.4 (rev. 05/2000) | Printed by Authority of the State of Illinois P.O. # 30M 02/00 | ||
Ill. Admin. Code tit. 77, pt. 500, app E, ILLUSTRATION M