TITLE 77: PUBLIC HEALTH
CHAPTER I: DEPARTMENT OF PUBLIC HEALTH
SUBCHAPTER e: VITAL RECORDS
PART 500 ILLINOIS VITAL RECORDS CODE
SECTION 500.APPENDIX A BIRTH RECORDS

Section 500.APPENDIX A   Birth Records

 

Section 500.ILLUSTRATION D   Certificate of Birth – Foundling Child

 

 

 

 

 

 

 

STATE OF ILLINOIS

 

CERTIFICATE OF BIRTH – FOUNDLING CHILD

 

 

 

File No.  ______________________

 

NAME GIVEN CHILD

BY CUSTODIAN:

PLACE CHILD

WAS FOUND:

(CITY, VILLAGE, TOWNSHIP OR ROAD DISTRICT)

(COUNTY)

DATE CHILD

WAS FOUND:

(MONTH)

(DAY)

(YEAR)

SEX

RACE

APPROXIMATED AGE:

 

 

 

 

 

 

NAME OF CUSTODIAN:

(PERSON OR INSTITUTION)

MAILING ADDRESS OF CUSTODIAN:

 

CHILD FOUND

BY:

 

MAILING ADDRESS OF FINDER:

 

REPORTED TO REGISTRAR ON:

(SIGNED)

LOCAL REGISTRAR

 

ILLINOIS DEPARTMENT OF PUBLIC HEALTH – DIVISION OF VITAL RECORDS

 

 

VR 102 (2/79)

 

(Source:  Added at 15 Ill. Reg. 11706, effective August 1, 1991)