Name of the Organization : Illinois Department of Public Health
Type of Facility : Obtain a Correct Death Certificate
State : Illinois
Country : United States of America
Website : http://www.dph.illinois.gov/topics-services/birth-death-other-records/death-records/correct-death-certificate
Application Form : https://www.statusin.org/uploads/24631-correction.pdf
Correct Death Certificate :
What You Will Need to Provide :
** Death certificates can be corrected under certain circumstances prescribed by the Vital Records Act (410 ILCS 535) and 77 Ill. Adm. Code Part 500 (see LAWS & RULES to the right).
** Every request is unique.
Related :Illinois Department of Public Health Obtain a Death Certificate : www.statusin.org/24627.html
** Every person entitled to request a correction, must complete an Affidavit and Certificate of Correction Request (see FORMS in the right-hand column).
** Because each request is different, additional documentation will be required and may vary, according to the type of correction requested.
** In order to request a correction to a death certificate you must complete the Affidavit and Certificate of Correction Request (see FORMS in the right-hand column)in its entirety and submit it along with the following information
** A valid government issued photo identification (ID) that must be readable and is not expired/out of date (if an ID is not provided, unreadable, or expired, the request will be returned unprocessed)
** To learn more about valid IDs, see RESOURCES in the right-hand column and click on IDs
** To learn more about the required costs/fees, see RESOURCES in the right-hand column and click on Costs/Fees
Types of Documents :
** The documents listed below are provided as general guidelines.
** In those cases when the documentation provided does not clearly support the change requested, you may need to obtain a court order (to learn more, see RESOURCES in the right-hand column).
| Type of Correction Requested | Suggested Documents |
| First Name | Birth record |
| Middle Name | Birth record |
| Last Name | Birth record |
| Marriage record | |
| Sex | Birth record |
| Date of Death | Medical records from place of death |
| Age | Birth record |
| Date of Birth | Birth record |
| Birthplace | Birth record |
| Marital/Civil Union Status and Surviving Spouse |
Marriage/civil union record/divorce/dissolution record |
| Surviving spouse’s birth record | |
| Marital/civil union proof such as: federal or state tax returns, bank statements, brokerage and loan accounts, insurance policies. All proof of Marital/Civil Union Status must have existed within two years of the date of death. | |
| Father/Co-parent’s Name | Birth record |
| Mother/Co-parent’s Name | Birth record |
| Informant’s Name | Informant’s birth record |
| Informant’s marriage/civil union record | |
| Funeral Home | Notarized statement from both funeral homes |
| Cause of Death | Certificate of Death Worksheet signed by certifying physician |
| Autopsy | Certificate of Death Worksheet signed by certifying physician |
| Date/Time/Location of Injury | Certificate of Death Worksheet signed by certifying physician |
| Manner of Death | Certificate of Death Worksheet signed by certifying physician |
| Date Physician Last Attended Deceased | Certificate of Death Worksheet signed by certifying physician |
| Time of Death | Certificate of Death Worksheet signed by certifying physician |
Affidavit And Certificate Of Correction Request Instructions :
1. Clearly print with a black pen or type all information.
2. Place a check mark by the record you are seeking to correct.
3. Any alterations, use of white-out or cross-outs will void this affidavit. If an error is made, start over with a new blank form.
4. Current Legal name means the name used at the time of the child’s birth (i.e. the name after marriage, after a court ordered name change or after a naturalization. This could also be the maiden name.).
5. Name prior to first marriage/civil union refers to the name given at birth; the maiden name or name that appears on a person’s birth record.
6. “Relationship” refers to the applicant’s relationship to the individual named on the record, for example, husband, mother, hospital birth clerk, daughter, individual serving as power of attorney or self.
7. “What you want corrected” should indicate the item (e.g., child’s first name, mother’s date of birth, father’s place of birth, marital status).
8. This form must be signed in the presence of a notary public. Notary publics are available at most banks and currency exchanges for a minimal fee.
9. 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.
** Please visit our website at idph.state.il.us/vitalrecords/correctioninfo.htm for more information concerning the types of documents needed.
Return all documents to:
Illinois Department Of Public Health
Division of Vital Records
925 E. Ridgely Ave.
Springfield, IL 62702-2737