Randolph County, IL · Randolph County
Birth Request Form
This form lets an applicant request a birth certificate from Randolph County by providing applicant, relationship, birth, copy, and intended-use information.
At a glance
- Issued by
- City of Randolph County · Randolph County, Randolph County, Illinois
- Notarization
- Not required: file this form without a notary.
- Official source
- randolphcountyil.gov
- Blank form
- Download the PDF
- Catalogued
- Machine-readable
- JSON record · about the forms index
What this form is
Use this form to request a birth certificate from Randolph County. It asks for the applicant’s name, address, phone number, relationship to the person named on the certificate, birth details, number of copies, and intended use. The request must include a photocopy of current identification, and the applicant signs the form.
Who needs it
Anyone requesting a birth certificate from Randolph County should complete this form and include a photocopy of current identification.
How to submit it
Mail the completed form and a photocopy of current identification to Randolph County Clerk, #1 Taylor Street, Room 202, Chester, IL 62233. The form lists (618) 826-5000 x191.
About notarization
This request is signed without a notary; the applicant signs the form and includes a photocopy of current identification.
How to submit this form
- 1
Download the Form
Download the Randolph County Birth Request Form.
- 2
Complete the Request
Enter the applicant’s contact information, relationship to the person on the certificate, birth details, number of copies, and intended use.
- 3
Gather Identification
Include a photocopy of current identification, as required by the form.
- 4
Sign and Mail
Sign the form and mail it with the identification photocopy to the Randolph County Clerk at the address shown on the form.
Frequently asked questions
- What information does the Birth Request Form ask for?
- It asks for the applicant’s name, address, phone number, relationship to the person on the certificate, birth information, number of copies, and intended use.
- What must I include with the birth request?
- The form says the request must include a photocopy of current identification. It also has a signature line for the applicant.
- How do I submit the Birth Request Form?
- Mail the completed form and a photocopy of current identification to Randolph County Clerk, #1 Taylor Street, Room 202, Chester, IL 62233.
- Do I need a notary for the Birth Request Form?
- No. This form has an applicant signature line but no notary block; the applicant signs it and includes a photocopy of current identification.