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
How to fill out Certificate For Custodian Of Records?
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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.
