Ill. Admin. Code tit. 77, pt. 500, app E, ILLUSTRATION E

Current through Register Vol. 48, No. 49, December 6, 2024

Birth Parent Registration Identification Form

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______________________________

(signature of birth parent)

______________________________	__________________________________
(date)	(printed or typed name of birth parent)

Illinois Department of Public Health, Division of Vital Records, 605 W. Jefferson St., Springfield, IL 62702-5097

VR 161.1 (rev.01/2000)Printed by Authority of the State of Illinois P.O. # 30M 02/00

Ill. Admin. Code tit. 77, pt. 500, app E, ILLUSTRATION E

Amended at 24 Ill. Reg. 11882, effective July 26, 2000