Illinois Department of Public Health - Adoption records · Illinois state form
Request for a Non-Certified Copy of Original Birth Certificate (IOCI 15-494)
Use this form to request a non-certified copy of an original birth certificate through the Illinois Adoption Registry and Medical Information Exchange.
- What this form is
- This form lets you request a non-certified copy of your original birth certificate or the original birth certificate of a deceased adopted or surrendered parent, grandparent, or spouse. It also lets you choose whether to receive a redacted copy if a birth parent requested anonymity. Submit a copy of a non-expired government-issued photo ID and a $15 check or money order payable to IDPH with your request.
- Who needs it
- People requesting a non-certified original birth certificate through IARMIE, including eligible surviving relatives registered with the exchange.
- Why it needs a notary
- Notarization is required if you select option 2 or 3; option 1 says a notary is not required. Required notarization can be completed online with a commissioned online notary.
- How to submit it
- Mail the completed request, a copy of a non-expired government-issued photo ID, and a $15 check or money order payable to IDPH to the Division of Vital Records - IARMIE address on the form.
Questions
Who can use this form?
The form is for people requesting a non-certified copy of an original birth certificate. A surviving relative requesting a deceased adopted or surrendered person's certificate must be registered with IARMIE.
Is a notary needed for this request?
A notary is not required for option 1, a request for your own original birth certificate. Options 2 and 3 require notarization, which can be done online with a commissioned online notary.
What should I include with my request?
Submit a copy of a non-expired, government-issued photo ID and a $15 check or money order made payable to IDPH with the completed form.