This form is used to certify that records submitted are true and correct and kept in the normal course of business.
Illinois Certificate for Custodian of Records
State:
Multi-State
Control #:
US-PI-0241
Format:
Word;
Rich Text
Instant download
Description
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Make edits, fill in missing information, and update formatting in US Legal Forms—just like you would in MS Word.
Download a copy, print it, send it by email, or mail it via USPS—whatever works best for your next step.
Sign and collect signatures with our SignNow integration. Send to multiple recipients, set reminders, and more. Go Premium to unlock E-Sign.
If this form requires notarization, complete it online through a secure video call—no need to meet a notary in person or wait for an appointment.
We protect your documents and personal data by following strict security and privacy standards.
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FAQ
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.
If it is your record, or the record of your child or spouse, you can contact the Illinois Department of Public Health (IDPH) to correct the error. Fill out the Affidavit and Certificate of Correction Request. Follow the instructions on the first page of the form. You must sign the form in front of a notary.
To obtain certified records you must submit a subpoena or court order which includes the following: Subject's name and identifying information (i.e.: date of birth, driver's license number, CII number, FBI number, etc.);
The following is a list of documents to include: ? Original affidavit signed by the person requesting the correction. A $15 check or money order made payable to IDPH. A copy of a non-expired, government issued photo ID of the person requesting the correction. Documentation required to complete the correction requested.
