Ill. Admin. Code tit. 77, pt. 500, app E, ILLUSTRATION L
Current through Register Vol. 48, No. 49, December 6, 2024
___________________________________ | ||||
(signature of non-surrendered birth sibling) | ||||
___________________________ | ___________________________________ | |||
(date) | (printed or typed name of non-surrendered birth sibling) | |||
Illinois Department of Public Health, Division of Vital Records, 605 W. Jefferson St., Springfield IL 62702-5097 | ||||
VR 161.6 (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 L