Illinois Department of Public Health - Death records · Illinois state form
Affidavit and Certificate of Correction Request
Request a correction to an Illinois birth, stillbirth/fetal death, or death record using this affidavit and certificate of correction form.
- What this form is
- Use this Illinois Department of Public Health form to request a correction to a birth, stillbirth/fetal death, or death record. The applicant provides information about the record, explains what is incorrect or missing, and states how it should be corrected. The form requires the applicant’s signature before a notary public and lists supporting documents to include with the request.
- Who needs it
- A person requesting a correction to an Illinois birth, stillbirth/fetal death, or death record, or someone completing the request on their behalf.
- Why it needs a notary
- The applicant must sign the affidavit in the presence of a notary public. This can be done online with a commissioned online notary.
- How to submit it
- Include the original signed affidavit, a $15 check or money order payable to IDPH, a copy of the applicant’s non-expired government-issued photo ID, and required documentation. Return all documents to the Division of Vital Records address listed in the instructions.
Questions
What records can I request to correct with this form?
The form allows requests to correct a birth, stillbirth/fetal death, or death record. It asks you to identify the record and describe what is incorrect or missing and how it should be corrected.
Does this form need to be notarized?
Yes. The instructions say the form must be signed in the presence of a notary public. You can do this online with a commissioned online notary.
What should I include with the correction request?
The instructions list the original affidavit signed by the requester, a $15 check or money order payable to IDPH, a copy of the requester’s non-expired government-issued photo ID, and documentation required for the correction.