Application for Evanston Illinois Death Certificate

Application for Evanston Illinois Death Record
Death Certificate - Long Form
Accepted for all legal use, passport and other governmental agencies
(contains the most information available)
$17.00 first certificate $6.00 each additional certificate +$20.00 shipping fee (online OR mail request)
Amount enclosed $ ________ for ________ total copies
DO NOT SEND CASH OR CHECK - Make money order payable to the CITY OF EVANSTON
For records prior to 1916, contact the County Clerk in the County where the death took place
BLANK SPACE FOR OFFICE USE 	DEATH CERTIFICATE NUMBER (If known)
FULL NAME ON DEATH RECORD (First, Middle, Last) 	POSSIBLE OTHER NAMES USED (Maiden, Married or Alias)
DATE OF ILLINOIS DEATH (Month, Day, Year) SEX 	DATE LAST KNOW TO BE ALIVE (Month, Day, Year)
PLACE OF EVANSTON ILLINOIS DEATH (Hospital, Nursing Home, etc.) 	LAST KNOWN ADDRESS (City, State or County)
BIRTHING PARENT NAME (Maiden Name) 	CO-PARENT OF DECEASED
NAME OF SURVIVING SPOUSE (If Married / Civil Union)
DECEDENTS DATE OF BIRTH 	DECEDENTS BIRTHPLACE DECEDENTS SOCIAL SECURITY NUMBER
NOTE: The State of Illinois, Division of Vital Records, in Springfield, issues certified death certificates from its electronic Illinois Vital Registration System (IVRS), if
the death occurred from 2008 forward. Any death record, from 2007 or before, is issued from the original paper record or from microfilm. As a result, these
certificates may look slightly different, according to the year of the event, but they are all certified copies and suitable for all legal purposes.
NAME OF INDIVIDUAL REQUESTING COPIES: 	REQUESTOR RELATIONSHIP (Relative, Spouse, Attorney, Estate, etc.)
REQUESTOR ADDRESS 	CITY 	STATE 	ZIP CODE
INTENDED USE 	REQUESTOR PHONE NUMBER REQUESTOR EMAIL ADDRESS
MAIL TO ADDRESS IF DIFFERENT THAN ABOVE 	CITY 	STATE 	ZIP CODE
SIGNATURE REQUIRED 	DATE
IF THE DEATH DID NOT OCCUR IN EVANSTON, IL YOU MUST CONTACT THE STATE WHERE THE DEATH TOOK PLACE
Complete Form IN FULL, sign, include copy of Identification & proper fee (Only send money orders or cashiers checks)
MAIL 	TO:
The 	Office 	of 	The 	City 	Clerk, 909 Davis Street 2nd Floor 	Evanston, 	IL 	60201
● For additional information - 	https://www.cityofevanston.org/government/city-clerk/vital-records
● Request 	in 	person 	to 	avoid 	shipping 	fees.
Vital records filed between November 2018 - October 17, 2021, must be obtained through the Cook County Clerk's Office.
REV: 04/18/2025

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IDENTIFICATION REQUIREMENTS
In order to process your request through this office we require identification to be provided
A photo copy of a NON-EXPIRED, GOVERNMENT ISSUED PHOTO IDENTIFICATION. Such as a Driver's License, Passport, FOID
card, Active Duty Military ID, Veterans Administration Issued Photo Medical Card, or a Federally issued Tribal ID card. ALL identification
MUST have a photo, identifying information such as name, date of birth and an issue and expiration date. If any information is
contained on both sides of the ID, ensure a copy of both sides is made.
If your ID has expired and has an extension sticker, ensure a copy of the sticker is also made.
If your ID has expired LESS THAN 6 MONTHS, please include one additional document showing your name and current address
created within the last 6 months. Examples include legal mail such as a bill or financial statement sent to your current legal address.
If your ID has expired MORE THAN 6 MONTHS or you DO NOT HAVE A VALID ID, you will be required to submit TWO forms of
documentation with your name and current legal address listed. Documentation in lieu of an ID must be dated within the last 6 months.
First Item - You must provide one or more of the following; Medical Card, Auto Insurance Card, Voter's Registration Card,Paycheck
Stub with Imprinted FULL information, Bank, Financial, or a Credit Card Statement.
Second Item - You must provide a piece of current mail you have received showing your full name and current legal mailing address.
Examples include the current utility bill, phone bill or bill for services you have received. You may submit multiple pieces of mail
however ensure they are from different Agencies or businesses.
If you are currently incarcerated in a State or Federal facility, you will need to submit a dated copy of your prison intake or offender
summary sheet containing your photo, name, date of birth and facility information.
If you have been RELEASED from prison WITHIN THE LAST 6 MONTHS, you may provide a copy of your release papers along with a
copy of your prison photo ID. Please note that the release papers MUST show an address that you have been released to that matches
the address you are using with this office.
If you are a State, Federal Agency or a Hospital, you may submit a copy of your work photo ID badge. The badge MUST have a photo,
name, name of the Agency and an issue and expiration date along with any supportive paperwork required for the request. If your work
ID does not meet the requirements, a copy of your government issued photo ID, Drivers License or Passport must also be included.
SOCIAL SECURITY CARDS ARE NOT ACCEPTABLE
ELIGIBILITY TO OBTAIN AN ILLINOIS DEATH RECORD
Before a request for an uncertified or certified copy can be considered, you must specify your eligibility to obtain it.
IlCS410/535/25/4(d) states that copies of death or fetal death records may be issued upon:
• The specific written request for an uncertified or certified copy by a person, or his duly authorized agent, having a genealogical,
(record must be over 20 years old), personal or property right interest in the record.
If you are eligible, please indicate on the front of this application your relationship to the deceased person, whose record
you are requesting, and the intended use of the copy.
NOTE: Any person who, willfully and knowingly uses or attempts to use, or furnishes to another for use, for any purpose
of deception, any certificate, record, report, certification or certified copy thereof so made, altered, amended, or mutilated;
or, Any person who with the intention to deceive, willfully uses or attempts to use any certification or certified copy of a
record of birth knowing that such certification or certified copy was issued upon a record that is false in whole or in part or
that relates to the birth of another person is guilty of a Class 4 felony in the State of Illinois (ILCS 410/535/27 (f)).
Illinois Law (ILCS 410/535/25 (1)) requires advanced payment for the search of death record files.
*Fees are subject to current Illinois Statute and administrative policy and may be non-refundable.*

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