Application for Evanston Illinois Birth Certificate

Application for Evanston Illinois Birth Record
Birth Certificate - Long Form
Accepted for all legal use, passport, and other governmental agencies
(contains the most information available)
$15.00 first certificate $4.00 for each additional certificate. There is a $20.00
shipping fee ONLY for online or mail requests.
Amount enclosed $ ________ for ________ total copies
FOR MAIL ORDERS DO NOT SEND CASH OR CHECK - Make a money order payable to the CITY OF
EVANSTON
FULL NAME ON BIRTH RECORD (First, Middle, Last) As listed on the Birth Record
DATE OF ILLINOIS BIRTH (Month, Day, Year) 	EVANSTON, IL Births ONLY 	SEX
BIRTHING PARENT NAME (Maiden Name Before First Marriage Required) As listed on the Birth Record
CO-PARENTS NAME As listed on the Birth Record
NOTE: Birth Certificates are confidential records, and birth records can only be issued to a person entitled to receive them. The application must indicate the
requestor’s relationship to the person listed on the record. For additional information, please see the reverse side or visit our website at
https://www.cityofevanston.org/govemment/city-clerk/vital-records
NAME OF INDIVIDUAL REQUESTING: 	REQUESTOR RELATIONSHIP (Mother, Father, Legal Guardian, etc.)
REQUESTOR ADDRESS 	CITY 	STATE 	ZIP CODE
REQUESTOR PHONE NUMBER 	REQUESTOR EMAIL ADDRESS
MAIL TO ADDRESS IF DIFFERENT THAN ABOVE CITY 	STATE 	ZIP CODE
SIGNATURE REQUIRED 	DATE
IF THE BIRTH DID NOT OCCUR IN EVANSTON, IL YOU MUST CONTACT THE STATE WHERE THE BIRTH TOOK PLACE
Complete the Form IN FULL, sign, and include a copy of your Identification & proper fee (Only send money orders or
cashier checks)
REQUEST IN PERSON OR 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.
Updated on 04/04/2025

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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 BIRTH RECORD
Before a request for a copy of a birth record can be considered you must specify your eligibility to obtain it. ILCS410/535/25(4) states
that copies of birth records may only be issued upon; The order of a court of competent jurisdiction; The specific written request by the
person listed on the record if of legal age (18 or older) or by a parent or other legal representative* of the person to whom the record of
birth relates; The specific written request by a Department of State, Municipal Corporation or the Federal Government
*77 Illinois AdmCode 500.10 refers to "Legal Representative" as either an attorney acting on behalf of a person named on the birth
record; An agent authorized by power of attorney; A Court-appointed representative; An agent with written, notarized authorization
from a person named on the birth record for the purpose of obtaining a copy for that person; Any other agent, approved by the State
Registrar as a legal representative.
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 (/LCS 410/535/27 (f)).
Illinois Law (/LCS 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.*
Updated on 04/04/2025

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