Who can request a Pike County birth record?

The form says a request may be made by the person named on the record if age 18 or older, a parent or legal representative, or an eligible government entity; a court order may also authorize issuance.

How do I submit the birth record search application?

Mail the completed application, proper fee by check or money order, and acceptable proof of identity to Pike County Health Department, 606 W. Adams Street, Pittsfield, IL 62363.

What identification should I include?

Include a non-expired government-issued photo ID. If you do not have one, the form describes alternative documentation, including two documents with your name, one of which must show your current address.

Pike County, IL · Pike County

No notary required

Application for Search of Birth Record Files

Adults, parents, legal representatives, and eligible government agencies use this application to request a search of Pike County birth record files.

At a glance

Issued by: City of Pike County · Pike County, Pike County, Illinois
Notarization: Not required: file this form without a notary.
Official source: pikecountyil.org
Blank form: Download the PDF
Catalogued: Oct 5, 2026
Machine-readable: JSON record · about the forms index

What this form is

This application lets an eligible requester ask Pike County Health Department to search for a birth record and request certified copies. It asks for the person’s birth details, the requester’s relationship and intended use, contact information, signature, and copy count. Mail the completed form with the proper fee and acceptable proof of identity; the form explains who may obtain a record and which identification documents are accepted.

Who needs it

A person eligible to obtain an Illinois birth record who wants Pike County Health Department to search its files and provide a certified copy needs this application.

How to submit it

Mail the completed form, proper fee by check or money order payable to Pike County Health Department, and required proof of identity to Pike County Health Department, 606 W. Adams Street, Pittsfield, IL 62363.

About notarization

This application is signed without a notary; an agent using written authorization from a person named on the birth certificate must provide notarized authorization.

How to submit this form

1
Download the Application
Download the birth record search application for Pike County.
2
Complete the Application
Provide the birth details, requester information, relationship, intended use, requested copy count, and signature.
3
Gather Required Items
Include the proper fee by check or money order and a legible copy of acceptable proof of identity.
4
Mail the Application
Mail the completed materials to Pike County Health Department, 606 W. Adams Street, Pittsfield, IL 62363.

Frequently asked questions

Who can request a Pike County birth record?: The form says a request may be made by the person named on the record if age 18 or older, a parent or legal representative, or an eligible government entity; a court order may also authorize issuance.
How do I submit the birth record search application?: Mail the completed application, proper fee by check or money order, and acceptable proof of identity to Pike County Health Department, 606 W. Adams Street, Pittsfield, IL 62363.
What identification should I include?: Include a non-expired government-issued photo ID. If you do not have one, the form describes alternative documentation, including two documents with your name, one of which must show your current address.
Do I need a notary for the birth record search application?: No. The application is signed without a notary. However, an agent using written authorization from a person named on the birth certificate must provide notarized authorization.

Need something notarized?

This Application for Search of Birth Record Files doesn’t need a notary, but Illinois residents can notarize other documents online with a commissioned online notary.