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

Current through Register Vol. 48, No. 49, December 6, 2024
Legal Guardian Registration Identification Form

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____________________________

(signature of legal guardian)

____________________________

____________________________

(date)

(printed or typed name of legal guardian)

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

VR 161.5 (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 N

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