(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.)