BIRTH CERTIFICATE REQUESTS

You must use this form, along with the required identification materials (see below) to receive birth certificates by mail from the Winnebago County Clerk. Print out the request form and send it along with $15.00 (1st copy) + (if needed) $4.00 for a second copy - check or money order and proper identification - to the address on the form.

                Cut along dotted lines
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                 JOHN SCHOU, County Clerk                     |
                                                              |
           Winnebago County Administration Bldg.              | 
                  404 Elm Street, Rm. 103                     |
                   Rockford, IL  61101                        |
                                                              |
                BIRTH CERTIFICATE REQUESTS                    | 
                                                              |
                                                              |
No.of Copies _________ **PLEASE SEND COPY OF ACTUAL RECORD**  |
Please Print Information                                      |
                                                              |
Name____________________________________________________      |
           First           Middle              Last           |
                                                              |
Date of Birth _________________Hospital Name ___________      |
                                                              |
                                                              |
Name of Father__________________________________________      |
                                                              |
                                                              |
Maiden Name of Mother___________________________________      |
                       First      Middle         Last         |
                                                              |
I, the undersigned, do hereby certify that as the person      |
whose record is sought, or as the parent, guardian, or        | 
legal representative of the person, am legally entitled       |
according to the Illinois Compiled Statutes                   |
(410 ILCS 535/25).                                            |
                                                              |
                                                              |
______________________    ________________________________    |
Print Your Name                  Your Signature               |
                                                              |
______________________    ________________________________    |
Address                  Relationship to Person on Document   |
                                                              |
______________________    ________________________________    |
City                                 Phone                    |
**********************************************************    |
            THIS AREA FOR MAIL-IN ONLY                        |
                                                              |
Mail to:  Name ___________________________________________    |
                                                              |
Address___________________________________________________    |
                                                              |
City_________________________State_________Zip____________    |
                                                              |
Date Mailed:_______________Deputy:________________________    |
                                                              |
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Acceptable Identification to Receive Records

* One of the following......

* or two of the following......


[Winnebago County] [County Clerk] [Marriage] [Death] [Taxes] [USGenWeb] [ILGenWeb]

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Katy Hestand

County Coordinator

Copyright 2005. All Rights Reserved. All materials contained on these pages are furnished for the free use of those individuals researching their family origins. ANY COMMERCIAL USE, PUBLICATION, OR POSTING OF THIS MATERIAL ON ANY OTHER WEBSITE, WITHOUT THE WRITTEN CONSENT OF THE CO-COORDINATOR/ AUTHOR/SUBMITTER OF THE MATERIAL/PAGE, IS PROHIBITED. All images used on these pages were obtained from sources permitting free distribution, or generated by the author, and are subject to the same restrictions/permissions. All persons contributing material for posting on these pages do so in recognition of their free, non-commercial distribution, and furthermore, are responsible to assure that no copyright is violated by their submission.

This page created by Cecelia Yeruski for the ILGenWeb Project.
Last updated: Monday, 18-Apr-2005 10:02:56 MDT