Illinois General Assembly - Illinois Compiled Statutes

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410 ILCS 535/25.7

(410 ILCS 535/25.7)
Sec. 25.7. Certification letter form.

In order to seek a waiver of the fee for a copy of a vital record, the person seeking the record must provide the following certification letter:

Certification Letter for Domestic Violence Waiver for Illinois Vital Records Full Name of Applicant:...............................
Date of Birth:........................................

I,........................, certify, to the best of my knowledge and belief, that on the date listed below, the above named individual is a victim or child of a victim of domestic violence, as defined by Section 103 of the Illinois Domestic Violence Act of 1986 (750 ILCS 60/103), who is currently fleeing a dangerous living situation. I provide this certification in my capacity as (check one below):

( ) an advocate at a family violence center who

assisted the victim;

( ) a licensed medical care or mental health provider;
( ) the director of an emergency shelter or

transitional housing; or

( ) the director of a transitional living program.
Signature:................. Date:........................
Title:..................... Employer:....................
Email:..................... Phone:.......................
Address:................... City:........................
State:..................... Zip:.........................
(Source: P.A. 103-170, eff. 1-1-24; 103-605, eff. 7-1-24.)