Form IOCI 16-577 Application for Verification of Marriage/Civil Union Record Files - Illinois

Form IOCI16-577 or the "Application For Verification Of Marriage/civil Union Record Files" is a form issued by the Illinois Department of Public Health.

Download a PDF version of the Form IOCI16-577 down below or find it on the Illinois Department of Public Health Forms website.

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State of Illinois
Illinois Department of Public Health
APPLICATION FOR VERIFICATION OF MARRIAGE/CIVIL UNION RECORD FILES
Certified copies can only be obtained by writing to the county clerk where the marriage occurred.
The Department began recording marriage information on January 1, 1962 and civil union information
on January 1, 2012.
FURNISH ALL POSSIBLE INFORMATION
Select one:
Marriage
Civil Union
Name of
First
Middle
Last/Maiden
Date of Birth
GROOM/
PARTNER
Name of
First
Middle
Last/Maiden
Date of Birth
BRIDE/
PARTNER
Place of
City
County
State
MARRIAGE/
CIVIL UNION
Date of
Month
Day
Year
MARRIAGE/
CIVIL UNION
For a non-refundable $5 fee (410 ILCS 530/3), facts of a marriage or civil union that took place between
1962 and current index year may be available. Additional copies of the same verification requested at the
same time are $5 each. For a non-refundable fee of $10 received from any federal or public agency of
another state (410 ILCS 535/25 (13)), facts of a marriage or civil union that took place between the
same years may be available.
Amount enclosed $ _________ for _________ total copies
APPLICATION MADE BY
Name
Street Address
City
State
ZIP
Signature
Make check or money order payable to Illinois Department of Public Health. DO NOT SEND CASH.
Return this form with the proper fee and a legible copy of your non-expired,
government issued photo I.D.
Mail To:
Illinois Department of Public Health
Division of Vital Records
925 E. Ridgely Ave.
Springfield, IL 62702-2737
IOCI 16-577
Printed by Authority of the State of Illinois
P.O.#1416152
5M
4/16
State of Illinois
Illinois Department of Public Health
APPLICATION FOR VERIFICATION OF MARRIAGE/CIVIL UNION RECORD FILES
Certified copies can only be obtained by writing to the county clerk where the marriage occurred.
The Department began recording marriage information on January 1, 1962 and civil union information
on January 1, 2012.
FURNISH ALL POSSIBLE INFORMATION
Select one:
Marriage
Civil Union
Name of
First
Middle
Last/Maiden
Date of Birth
GROOM/
PARTNER
Name of
First
Middle
Last/Maiden
Date of Birth
BRIDE/
PARTNER
Place of
City
County
State
MARRIAGE/
CIVIL UNION
Date of
Month
Day
Year
MARRIAGE/
CIVIL UNION
For a non-refundable $5 fee (410 ILCS 530/3), facts of a marriage or civil union that took place between
1962 and current index year may be available. Additional copies of the same verification requested at the
same time are $5 each. For a non-refundable fee of $10 received from any federal or public agency of
another state (410 ILCS 535/25 (13)), facts of a marriage or civil union that took place between the
same years may be available.
Amount enclosed $ _________ for _________ total copies
APPLICATION MADE BY
Name
Street Address
City
State
ZIP
Signature
Make check or money order payable to Illinois Department of Public Health. DO NOT SEND CASH.
Return this form with the proper fee and a legible copy of your non-expired,
government issued photo I.D.
Mail To:
Illinois Department of Public Health
Division of Vital Records
925 E. Ridgely Ave.
Springfield, IL 62702-2737
IOCI 16-577
Printed by Authority of the State of Illinois
P.O.#1416152
5M
4/16

Download Form IOCI 16-577 Application for Verification of Marriage/Civil Union Record Files - Illinois

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