Bill Text: IL HB3967 | 2015-2016 | 99th General Assembly | Chaptered

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Bill Title: Amends the Adoption Act. Defines "birth grandparent" as the biological parent of a non-surrendered person who is a deceased birth parent. Provides that a birth grandparent who has submitted birth certificates for himself or herself and for a deceased birth parent as well as proof of death for the deceased birth parent may file a Registration Identification Form and an Information Exchange Authorization or a Denial of Information Exchange if the birth parent did not file documentation preventing the exchange of information prior to his or her death. Makes corresponding changes.

Spectrum: Moderate Partisan Bill (Democrat 6-1)

Status: (Passed) 2015-08-11 - Public Act . . . . . . . . . 99-0345 [HB3967 Detail]

Download: Illinois-2015-HB3967-Chaptered.html

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Public Act 099-0345
HB3967 Enrolled LRB099 06337 HEP 26407 b
AN ACT concerning civil law.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The Adoption Act is amended by changing Sections
18.06, 18.1, 18.1a, 18.1b, 18.2, 18.3a, and 18.6 as follows:
(750 ILCS 50/18.06)
Sec. 18.06. Definitions. When used in Sections 18.05
through Section 18.6, for the purposes of the Registry:
"Adopted person" means a person who was adopted pursuant to
the laws in effect at the time of the adoption.
"Adoptive parent" means a person who has become a parent
through the legal process of adoption.
"Adult child" means the biological child 21 years of age or
over of a deceased adopted or surrendered person.
"Adult grandchild" means the biological grandchild 21
years of age or over of a deceased adopted or surrendered
person.
"Adult adopted or surrendered person" means an adopted or
surrendered person 21 years of age or over.
"Agency" means a public child welfare agency or a licensed
child welfare agency.
"Birth aunt" means the adult full or half sister of a
deceased birth parent.

"Birth father" means the biological father of an adopted or
surrendered person who is named on the original certificate of
live birth or on a consent or surrender document, or a
biological father whose paternity has been established by a
judgment or order of the court, pursuant to the Illinois
Parentage Act of 1984.
"Birth grandparent" means the biological parent of: (i) a
non-surrendered person who is a deceased birth mother; or (ii)
a non-surrendered person who is a deceased birth father.
"Birth mother" means the biological mother of an adopted or
surrendered person.
"Birth parent" means a birth mother or birth father of an
adopted or surrendered person.
"Birth Parent Preference Form" means the form prepared by
the Department of Public Health pursuant to Section 18.2
completed by a birth parent registrant and filed with the
Registry that indicates the birth parent's preferences
regarding contact and, if applicable, the release of his or her
identifying information on the non-certified copy of the
original birth certificate released to an adult adopted or
surrendered person or to the surviving adult child or surviving
spouse of a deceased adopted or surrendered person who has
filed a Request for a Non-Certified Copy of an Original Birth
Certificate.
"Birth relative" means a birth mother, birth father, birth
grandparent, birth sibling, birth aunt, or birth uncle.

"Birth sibling" means the adult full or half sibling of an
adopted or surrendered person.
"Birth uncle" means the adult full or half brother of a
deceased birth parent.
"Confidential intermediary" means an individual certified
by the Department of Children and Family Services pursuant to
Section 18.3a(e).
"Denial of Information Exchange" means an affidavit
completed by a registrant with the Illinois Adoption Registry
and Medical Information Exchange denying the release of
identifying information which has been filed with the Registry.
"Information Exchange Authorization" means an affidavit
completed by a registrant with the Illinois Adoption Registry
and Medical Information Exchange authorizing the release of
identifying information which has been filed with the Registry.
"Medical Information Exchange Questionnaire" means the
medical history questionnaire completed by a registrant of the
Illinois Adoption Registry and Medical Information Exchange.
"Non-certified Copy of the Original Birth Certificate"
means a non-certified copy of the original certificate of live
birth of an adult adopted or surrendered person who was born in
Illinois.
"Proof of death" means a death certificate.
"Registrant" or "Registered Party" means a birth parent,
birth grandparent, birth sibling, birth aunt, birth uncle,
adopted or surrendered person 21 years of age or over, adoptive

parent or legal guardian of an adopted or surrendered person
under the age of 21, or adoptive parent, surviving spouse, or
adult child of a deceased adopted or surrendered person who has
filed an Illinois Adoption Registry Application or
Registration Identification Form with the Registry.
"Registry" means the Illinois Adoption Registry and
Medical Information Exchange.
"Request for a Non-Certified Copy of an Original Birth
Certificate" means an affidavit completed by an adult adopted
or surrendered person or by the surviving adult child or
surviving spouse of a deceased adopted or surrendered person
and filed with the Registry requesting a non-certified copy of
an adult adopted or surrendered person's original certificate
of live birth in Illinois.
"Surrendered person" means a person whose parents' rights
have been surrendered or terminated but who has not been
adopted.
"Surviving spouse" means the wife or husband, 21 years of
age or older, of a deceased adopted or surrendered person who
would be 21 years of age or older if still alive and who has one
or more surviving biological children who are under the age of
21.
"18.3 statement" means a statement regarding the
disclosure of identifying information signed by a birth parent
under Section 18.3 of this Act as it existed immediately prior
to the effective date of this amendatory Act of the 96th

General Assembly.
(Source: P.A. 97-110, eff. 7-14-11; 98-704, eff. 1-1-15.)
(750 ILCS 50/18.1) (from Ch. 40, par. 1522.1)
Sec. 18.1. Disclosure of identifying information.
(a) The Department of Public Health shall establish and
maintain a Registry for the purpose of allowing mutually
consenting members of birth and adoptive families to exchange
identifying and medical information. Identifying information
for the purpose of this Act shall mean any one or more of the
following:
(1) The name and last known address of the consenting
person or persons.
(2) A copy of the Illinois Adoption Registry
Application of the consenting person or persons.
(3) A non-certified copy of the original birth
certificate of an adult adopted or surrendered person.
(b) Written authorization from all parties identified must
be received prior to disclosure of any identifying information,
with the exception of non-certified copies of original birth
certificates released to adult adopted or surrendered persons
or to surviving adult children and surviving spouses of
deceased adopted or surrendered persons pursuant to the
procedures outlined in Section 18.1b(e).
(c) At any time after a child is surrendered for adoption,
or at any time during the adoption proceedings or at any time

thereafter, either birth parent or both of them may file with
the Registry a Birth Parent Registration Identification Form.
(d) A birth sibling 21 years of age or over who was not
surrendered for adoption and who has submitted a copy of his or
her birth certificate as well as proof of death for a deceased
birth parent and such birth parent did not file a Denial of
Information Exchange or a Birth Parent Preference Form on which
Option E was selected with the Registry prior to his or her
death may file a Registration Identification Form and an
Information Exchange Authorization or a Denial of Information
Exchange.
(e) A birth aunt or birth uncle who has submitted birth
certificates for himself or herself and for a deceased birth
parent naming at least one common biological parent as well as
proof of death for the deceased birth parent and such birth
parent did not file a Denial of Information Exchange or a Birth
Parent Preference Form on which Option E was selected with the
Registry prior to his or her death may file a Registration
Identification Form and an Information Exchange Authorization
or a Denial of Information Exchange.
(e-5) A birth grandparent who has submitted birth
certificates for himself or herself and for a deceased birth
parent as well as proof of death for the deceased birth parent
and the birth parent did not file a Denial of Information
Exchange or a Birth Parent Preference Form on which Option E
was selected with the Registry prior to his or her death may

file a Registration Identification Form and an Information
Exchange Authorization or a Denial of Information Exchange.
(f) Any adopted person 21 years of age or over, any
surrendered person 21 years of age or over, or any adoptive
parent or legal guardian of an adopted or surrendered person
under the age of 21 may file with the Registry a Registration
Identification Form and an Information Exchange Authorization
or a Denial of Information Exchange.
(g) Any adult child or adult grandchild 21 years of age or
over of a deceased adopted or surrendered person who has
submitted a copy of his or her birth certificate naming an
adopted or surrendered person as his or her biological parent
as well as proof of death for the deceased adopted or
surrendered person and such adopted or surrendered person did
not file a Denial of Information Exchange with the Registry
prior to his or her death may file a Registration
Identification Form and an Information Exchange Authorization
or a Denial of Information Exchange.
(h) Any surviving spouse of a deceased adopted or
surrendered person 21 years of age or over who has submitted
proof of death for the deceased adopted or surrendered person
and such adopted or surrendered person did not file a Denial of
Information Exchange with the Registry prior to his or her
death as well as a birth certificate naming themselves and the
adopted or surrendered person as the parents of a minor child
under the age of 21 may file a Registration Identification Form

and an Information Exchange Authorization or a Denial of
Information Exchange.
(i) Any adoptive parent or legal guardian of a deceased
adopted or surrendered person who is 21 years of age or over
who has submitted proof of death as well as proof of parentage
or guardianship for the deceased adopted or surrendered person
and such adopted or surrendered person did not file a Denial of
Information Exchange with the Registry prior to his or her
death may file a Registration Identification Form and an
Information Exchange Authorization or a Denial of Information
Exchange.
(j) The Department of Public Health shall supply to the
adopted or surrendered person or his or her adoptive parents,
legal guardians, adult children, adult grandchildren, or
surviving spouse, and to the birth parents identifying
information only if both the adopted or surrendered person, or
one of his or her adoptive parents, legal guardians, adult
children, adult grandchildren, or his or her surviving spouse,
and the birth parents have filed with the Registry an
Information Exchange Authorization or a Birth Parent
Preference Form on which Option A, B, or C was selected and the
information at the Registry indicates that the consenting
adopted or surrendered person, the child of the consenting
adoptive parents or legal guardians, the parent of the
consenting adult child of the adopted or surrendered person, or
the deceased wife or husband of the consenting surviving spouse

is the child of the consenting birth parents, except
identifying information that appears on a non-certified copy of
an original birth certificate may be provided to an adult
adopted or surrendered person or to the surviving adult child,
adult grandchild, or surviving spouse of a deceased adopted or
surrendered person pursuant to the procedures outlined in
Section 18.1b(e) of this Act.
The Department of Public Health shall supply to adopted or
surrendered persons who are birth siblings identifying
information only if both siblings have filed with the Registry
an Information Exchange Authorization and the information at
the Registry indicates that the consenting siblings have one or
both birth parents in common. Identifying information shall be
supplied to consenting birth siblings who were adopted or
surrendered if any such sibling is 21 years of age or over.
Identifying information shall be supplied to consenting birth
siblings who were not adopted or surrendered if any such
sibling is 21 years of age or over and has proof of death of the
common birth parent and such birth parent did not file a Denial
of Information Exchange or a Birth Parent Preference Form on
which Option E was selected with the Registry prior to his or
her death.
(k) The Department of Public Health shall supply to the
adopted or surrendered person or his or her adoptive parents,
legal guardians, adult children, adult grandchildren, or
surviving spouse, and to a birth aunt identifying information

only if both the adopted or surrendered person or one of his or
her adoptive parents, legal guardians, adult children, adult
grandchildren, or his or her surviving spouse, and the birth
aunt have filed with the Registry an Information Exchange
Authorization and the information at the Registry indicates
that the consenting adopted or surrendered person, or the child
of the consenting adoptive parents or legal guardians, or the
parent of the consenting adult child, or the deceased wife or
husband of the consenting surviving spouse of the adopted or
surrendered person is or was the child of the brother or sister
of the consenting birth aunt.
(k-5) The Department of Public Health shall supply to the
adopted or surrendered person and to a birth grandparent
identifying information only if both the adopted or surrendered
person and the birth grandparent have filed with the Registry
an Information Exchange Authorization and the information at
the Registry indicates that the consenting adopted or
surrendered person is or was the child of a deceased birth
mother or birth father.
(l) The Department of Public Health shall supply to the
adopted or surrendered person or his or her adoptive parents,
legal guardians, adult children, adult grandchildren, or
surviving spouse, and to a birth uncle identifying information
only if both the adopted or surrendered person or one of his or
her adoptive parents, legal guardians, adult children, adult
grandchildren, or his or her surviving spouse, and the birth

uncle have filed with the Registry an Information Exchange
Authorization and the information at the Registry indicates
that the consenting adopted or surrendered person, or the child
of the consenting adoptive parents or legal guardians, or the
parent of the consenting adult child, or the deceased wife or
husband of the consenting surviving spouse of the adopted or
surrendered person is or was the child of the brother or sister
of the consenting birth uncle.
(m) A registrant may notify the Registry of his or her
desire not to have identifying information revealed or may
revoke any previously filed Information Exchange Authorization
by completing and filing with the Registry a Registry
Identification Form along with a Denial of Information Exchange
or, if applicable, a Birth Parent Preference Form. Any
registrant, except a birth parent, may revoke his or her Denial
of Information Exchange by filing an Information Exchange
Authorization. A birth parent may revoke a Denial of
Information Exchange by filing a Birth Parent Preference Form.
Any birth parent who has previously filed a Birth Parent
Preference Form where Option E was selected may revoke such
preference by filing a subsequent Birth Parent Preference Form
and selecting Option A, B, C, or D. The Department of Public
Health shall act in accordance with the most recently filed
affidavit.
(n) Identifying information ascertained from the Registry
shall be confidential and may be disclosed only (1) upon a

Court Order, which order shall name the person or persons
entitled to the information, or (2) to a registrant who is the
subject of an Information Exchange Authorization or, if
applicable, a Birth Parent Preference Form that was completed
by another registrant and filed with the Illinois Adoption
Registry and Medical Information Exchange, or (3) as authorized
under subsection (h) of Section 18.3 of this Act, or (4)
pursuant to the procedures outlined in Section 18.1b(e) of this
Act. Any person who willfully provides unauthorized disclosure
of any information filed with the Registry or who knowingly or
intentionally files false information with the Registry shall
be guilty of a Class A misdemeanor and shall be liable for
damages.
(o) If information is disclosed pursuant to this Act, the
Department shall redact it to remove any identifying
information about any party who has not consented to the
disclosure of such identifying information, or, in the case of
identifying information on the original birth certificate,
pursuant to Section 18.1b(e) of this Act.
(Source: P.A. 97-110, eff. 7-14-11; 98-704, eff. 1-1-15.)
(750 ILCS 50/18.1a)
Sec. 18.1a. Registry matches.
(a) The Registry shall release identifying information, as
specified on the applicant's Information Exchange
Authorization or, if applicable, a Birth Parent Preference

Form, to the following mutually consenting registered parties
and provide them with any photographs or correspondence which
have been placed in the Adoption/Surrender Records File and are
specifically intended for the registered parties:
(i) an adult adopted or surrendered person and one of
his or her birth relatives who have both filed an
applicable Information Exchange Authorization or, if
applicable, a Birth Parent Preference Form specifying the
other consenting party with the Registry, if information
available to the Registry confirms that the consenting
adopted or surrendered person is biologically related to
the consenting birth relative;
(ii) the adoptive parent or legal guardian of an
adopted or surrendered person under the age of 21 and one
of the adopted or surrendered person's birth relatives who
have both filed an Information Exchange Authorization
specifying the other consenting party, or, if applicable, a
Birth Parent Preference Form, with the Registry, if
information available to the Registry confirms that the
child of the consenting adoptive parent or legal guardian
is biologically related to the consenting birth relative;
and
(iii) the adoptive parent, adult child, adult
grandchild, birth grandparent, or surviving spouse of a
deceased adopted or surrendered person, and one of the
adopted or surrendered person's birth relatives who have

both filed an applicable Information Exchange
Authorization specifying the other consenting party or, if
applicable, a Birth Parent Preference Form, with the
Registry, if information available to the Registry
confirms that the child of the consenting adoptive parent,
the parent of the consenting adult child or the deceased
wife or husband of the consenting surviving spouse of the
adopted or surrendered person was biologically related to
the consenting birth relative.
(b) If a registrant is the subject of a Denial of
Information Exchange filed by another registered party or is an
adopted or surrendered person, or the surviving relative of a
deceased adopted or surrendered person, and a birth parent of
the adopted or surrendered person completed a Birth Parent
Preference Form and selected Option E, the Registry shall not
release identifying information to either registrant or, if
applicable, to an adopted person who has requested a copy of
his or her original birth certificate, with the exception of
non-certified copies of the original birth certificate
released under Section 18.1b(e), and as to a birth parent who
has prohibited release of identifying information on the
original birth certificate to the adult adopted or surrendered
person, upon the death of said birth parent.
(c) If a registrant has completed a Medical Information
Exchange Questionnaire and has consented to its disclosure,
that Questionnaire shall be released to any registered party

who has indicated their desire to receive such information on
his or her Illinois Adoption Registry Application, if
information available to the Registry confirms that the
consenting parties are biologically related, that the
consenting birth relative and the child of the consenting
adoptive parents or legal guardians are birth relatives, or
that the consenting birth relative and the deceased wife or
husband of the consenting surviving spouse are birth relatives.
(Source: P.A. 97-110, eff. 7-14-11; 98-704, eff. 1-1-15.)
(750 ILCS 50/18.1b)
Sec. 18.1b. The Illinois Adoption Registry Application.
The Illinois Adoption Registry Application shall substantially
include the following:
(a) General Information. The Illinois Adoption
Registry Application shall include the space to provide
Information about the registrant including his or her
surname, given name or names, social security number
(optional), mailing address, home telephone number,
gender, date and place of birth, and the date of
registration. If applicable and known to the registrant, he
or she may include the maiden surname of the birth mother,
any subsequent surnames of the birth mother, the surname of
the birth father, the given name or names of the birth
parents, the dates and places of birth of the birth
parents, the surname and given name or names of the adopted

person prior to adoption, the gender and date and place of
birth of the adopted or surrendered person, the name of the
adopted person following his or her adoption and the state
and county where the judgment of adoption was finalized.
(b) Medical Information Exchange Questionnaire. In
recognition of the importance of medical information and of
recent discoveries regarding the genetic origin of many
medical conditions and diseases all registrants shall be
asked to voluntarily complete a Medical Information
Exchange Questionnaire. The Medical Information Exchange
Questionnaire shall include a comprehensive check-list of
medical conditions and diseases including those of genetic
origin.
(1) Birth relatives shall be asked to indicate all
genetically-inherited diseases and conditions on this
list which are known to exist in the adopted or
surrendered person's birth family at the time of
registration. In addition, all birth relatives shall
be apprised of the Registry's provisions for
voluntarily submitting information about their and
their family's medical histories on a confidential,
ongoing basis.
(2) Adopted and surrendered persons and their
adoptive parents, legal guardians, adult children,
adult grandchildren, and surviving spouses shall be
asked to indicate all genetically-inherited diseases

and medical conditions with which the adopted or
surrendered person or, if applicable, his or her
children have been diagnosed since birth.
(3) The Medical Information Exchange Questionnaire
shall include a space where the registrant may
authorize the release of the Medical Information
Exchange Questionnaire to specified registered parties
and a disclaimer informing registrants that the
Department of Public Health cannot guarantee the
accuracy of medical information exchanged through the
Registry.
(c) Written statement. All registrants shall be given
the opportunity to voluntarily file a written statement
with the Registry. This statement shall be submitted in the
space provided. No written statement submitted to the
Registry shall include identifying information pertaining
to any person other than the registrant who submitted it.
Any such identifying information shall be redacted by the
Department or returned for removal of identifying
information.
(d) Exchange of information. All registrants except
birth parents may indicate their wishes regarding contact
and the exchange of identifying and/or medical information
with any other registrant by completing an Information
Exchange Authorization or a Denial of Information
Exchange. Birth parents may indicate their wishes

regarding contact by filing a Birth Parent Preference Form
pursuant to the procedures outlined in this Section.
(1) Information Exchange Authorization. Adopted or
surrendered persons 21 years of age or over who are
interested in exchanging identifying and/or medical
information or would welcome contact with one or more
of their birth relatives; birth siblings 21 years of
age or over who were adopted or surrendered and who are
interested in exchanging identifying and/or medical
information or would welcome contact with an adopted or
surrendered person, or one or more of his or her
adoptive parents, legal guardians, adult children,
adult grandchildren, or a surviving spouse; birth
siblings 21 years of age or over who were not
surrendered and who have submitted proof of death for
any common birth parent who did not file a Denial of
Information Exchange or a Birth Parent Preference Form
on which Option E was selected prior to his or her
death, and who are interested in exchanging
identifying and/or medical information or would
welcome contact with an adopted or surrendered person,
or one or more of his or her adoptive parents, legal
guardians, adult children, adult grandchildren, or a
surviving spouse; birth aunts and birth uncles 21 years
of age or over who have submitted birth certificates
for themselves and a deceased birth parent naming at

least one common biological parent as well as proof of
death for a deceased birth parent and who are
interested in exchanging identifying and/or medical
information or would welcome contact with an adopted or
surrendered person 21 years of age or over, or one or
more of his or her adoptive parents, legal guardians,
adult children, adult grandchildren, or a surviving
spouse; birth grandparents who have submitted birth
certificates for themselves and a deceased birth
parent as well as proof of death for a deceased birth
parent and who are interested in exchanging
identifying and/or medical information or would
welcome contact with an adopted or surrendered person
21 years of age or over, or one or more of his or her
adoptive parents, legal guardians, adult children,
adult grandchildren, or a surviving spouse; adoptive
parents or legal guardians of adopted or surrendered
persons under the age of 21 who are interested in
exchanging identifying and/or medical information or
would welcome contact with one or more of the adopted
or surrendered person's birth relatives; adoptive
parents and legal guardians of deceased adopted or
surrendered persons 21 years of age or over who have
submitted proof of death for a deceased adopted or
surrendered person who did not file a Denial of
Information Exchange prior to his or her death and who

are interested in exchanging identifying and/or
medical information or would welcome contact with one
or more of the adopted or surrendered person's birth
relatives; adult children of deceased adopted or
surrendered persons who have submitted a birth
certificate naming the adopted or surrendered person
as their biological parent, and, in the case of adult
grandchildren, their birth certificate and a birth
certificate naming the adopted or surrendered person
as their parent's biological parent, and proof of death
for an adopted or surrendered person who did not file a
Denial of Information Exchange prior to his or her
death; and surviving spouses of deceased adopted or
surrendered persons who have submitted a marriage
certificate naming an adopted or surrendered person as
their deceased wife or husband and proof of death for
an adopted or surrendered person who did not file a
Denial of Information Exchange prior to his or her
death and who are interested in exchanging identifying
and/or medical information or would welcome contact
with one or more of the adopted or surrendered person's
birth relatives may specify with whom they wish to
exchange identifying information by filing an
Information Exchange Authorization.
(2) Denial of Information Exchange. Adopted or
surrendered persons 21 years of age or over who do not

wish to exchange identifying information or establish
contact with one or more of their birth relatives may
specify with whom they do not wish to exchange
identifying information or do not wish to establish
contact by filing a Denial of Information Exchange.
Birth relatives other than birth parents who do not
wish to establish contact with an adopted or
surrendered person or one or more of his or her
adoptive parents, legal guardians, or adult children
or adult grandchildren may specify with whom they do
not wish to exchange identifying information or do not
wish to establish contact by filing a Denial of
Information Exchange. Birth parents who wish to
prohibit the release of their identifying information
on the original birth certificate released to an adult
adopted or surrendered person who was born after
January 1, 1946, or to the surviving adult child, adult
grandchild, or surviving spouse of a deceased adopted
or surrendered person who was born after January 1,
1946, may do so by filing a Denial with the Registry on
or before December 31, 2010. Adoptive parents or legal
guardians of adopted or surrendered persons under the
age of 21 who do not wish to establish contact with one
or more of the adopted or surrendered person's birth
relatives may specify with whom they do not wish to
exchange identifying information by filing a Denial of

Information Exchange. Adoptive parents, adult
children, adult grandchildren, and surviving spouses
of deceased adoptees who do not wish to exchange
identifying information or establish contact with one
or more of the adopted or surrendered person's birth
relatives may specify with whom they do not wish to
exchange identifying information or do not wish to
establish contact by filing a Denial of Information
Exchange.
(3) Birth Parent Preference Form. Beginning
January 1, 2011, birth parents who are eligible to
register with the Illinois Adoption Registry and
Medical Information Exchange and whose birth child was
born on or after January 1, 1946 may communicate their
wishes regarding contact or may prohibit the release of
identifying information on the non-certified copy of
the original birth certificate released under
subsection (e) of this Section by filing a Birth Parent
Preference Form with the Registry. Birth parents whose
birth child was born before January 1, 1946, may
communicate their wishes regarding contact by
completing a Birth Parent Preference Form, selecting
Option A, B, C, or D, and filing the form with the
Registry, but may not prohibit the release of
identifying information. All Birth Parent Preference
Forms on file with the Registry at the time of receipt

of a Request for a Non-Certified Copy of an Original
Birth Certificate from an adult adopted or surrendered
person or the surviving adult child, surviving adult
grandchild, or surviving spouse of a deceased adopted
or surrendered person shall be forwarded to the
relevant adopted or surrendered person or surviving
adult child, surviving adult grandchild, or surviving
spouse of a deceased adopted or surrendered person
along with a non-certified copy of the adopted or
surrendered person's original birth certificate as
outlined in subsection (e) of this Section.
(e) Procedures for requesting a non-certified copy of
an original birth certificate by an adult adopted or
surrendered person or by a surviving adult child, adult
grandchild, or surviving spouse of a deceased adopted or
surrendered person:
(1) On or after the effective date of this
amendatory Act of the 96th General Assembly, any adult
adopted or surrendered person who was born in Illinois
prior to January 1, 1946, may complete and file with
the Registry a Request for a Non-Certified Copy of an
Original Birth Certificate. The Registry shall provide
such adult adopted or surrendered person with an
unaltered, non-certified copy of his or her original
birth certificate upon receipt of the Request for a
Non-Certified Copy of an Original Birth Certificate.

Additionally, in cases where an adopted or surrendered
person born in Illinois prior to January 1, 1946, is
deceased, and one of his or her surviving adult
children, adult grandchildren, or his or her surviving
spouse has registered with the Registry, he or she may
complete and file with the Registry a Request for a
Non-Certified Copy of an Original Birth Certificate.
The Registry shall provide such surviving adult child,
adult grandchild, or surviving spouse with an
unaltered, non-certified copy of the adopted or
surrendered person's original birth certificate upon
receipt of the Request for a Non-Certified Copy of an
Original Birth Certificate.
(2) Beginning November 15, 2011, any adult adopted
or surrendered person who was born in Illinois on or
after January 1, 1946, may complete and file with the
Registry a Request for a Non-certified Copy of an
Original Birth Certificate. Additionally, in cases
where the adopted or surrendered person is deceased and
one of his or her surviving adult children, adult
grandchildren, or his or her surviving spouse has
registered with the Registry, he or she may complete
and file with the Registry a Request for a
Non-Certified Copy of an Original Birth Certificate.
Upon receipt of such request from an adult adopted or
surrendered person or from one of his or her surviving

adult children, adult grandchildren, or his or her
surviving spouse, the Registry shall:
(i) Determine if there is a Denial of
Information Exchange which was filed by a birth
parent named on the original birth certificate
prior to January 1, 2011. If a Denial was filed by
a birth parent named on the original birth
certificate prior to January 1, 2011, and there is
no proof of death in the Registry file for the
birth parent who filed said Denial, the Registry
shall inform the requesting adult adopted or
surrendered person or the requesting surviving
adult child, adult grandchild, or surviving spouse
of a deceased adopted or surrendered person that
they may receive a non-certified copy of the
original birth certificate from which all
identifying information pertaining to the birth
parent who filed the Denial has been redacted. A
requesting adult adopted or surrendered person
shall also be informed in writing of his or her
right to petition the court for the appointment of
a confidential intermediary pursuant to Section
18.3a of this Act and, if applicable, to conduct a
search through an agency post-adoption search
program once 5 years have elapsed since the birth
parent filed the Denial of Information Exchange

with the Registry.
(ii) Determine if a birth parent named on the
original birth certificate has filed a Birth
Parent Preference Form. If one of the birth parents
named on the original birth certificate filed a
Birth Parent Preference Form and selected Option
A, B, C, or D, the Registry shall forward to the
adult adopted or surrendered person or to the
surviving adult child, adult grandchild, or
surviving spouse of a deceased adopted or
surrendered person a copy of the Birth Parent
Preference Form along with an unaltered
non-certified copy of his or her original birth
certificate. If one of the birth parents named on
the original birth certificate filed a Birth
Parent Preference Form and selected Option E, and
there is no proof of death in the Registry file for
the birth parent who filed said Birth Parent
Preference Form, the Registry shall inform the
requesting adult adopted or surrendered person or
the requesting surviving adult child, adult
grandchild, or surviving spouse of a deceased
adopted or surrendered person that he or she may
receive a non-certified copy of the original birth
certificate from which identifying information
pertaining to the birth parent who completed the

Birth Parent Preference Form has been redacted per
the birth parent's specifications on the Form. The
Registry shall forward to the adult adopted or
surrendered person or to the surviving adult
child, adult grandchild, or surviving spouse of a
deceased adopted or surrendered person a copy of
the Birth Parent Preference Form filed by the birth
parent from which identifying information has been
redacted per the birth parent's specifications on
the Form. The requesting adult adopted or
surrendered person shall also be informed in
writing of his or her right to petition the court
for the appointment of a confidential intermediary
pursuant to Section 18.3a of this Act, and, if
applicable, to conduct a search through an agency
post-adoption search program once 5 years have
elapsed since the birth parent filed the Birth
Parent Preference Form, on which Option E was
selected, with the Registry.
(iii) Determine if a birth parent named on the
original birth certificate has filed an
Information Exchange Authorization.
(iv) If the Registry has confirmed that a
requesting adult adopted or surrendered person or
the parent of a requesting adult child of a
deceased adopted or surrendered person or the

husband or wife of a requesting surviving spouse
was not the object of a Denial of Information
Exchange filed by a birth parent on or before
December 31, 2010, and that no birth parent named
on the original birth certificate has filed a Birth
Parent Preference Form where Option E was selected
prior to the receipt of a Request for a
Non-Certified Copy of an Original Birth
Certificate, the Registry shall provide the adult
adopted or surrendered person or his or her
surviving adult child or surviving spouse with an
unaltered non-certified copy of the adopted or
surrendered person's original birth certificate.
(3) In cases where the Registry receives a Birth
Parent Preference Form from a birth parent subsequent
to the release of the non-certified copy of the
original birth certificate to an adult adopted or
surrendered person or to the surviving adult child,
adult grandchild, or surviving spouse of a deceased
adopted or surrendered person, the Birth Parent
Preference Form shall be immediately forwarded to the
adult adopted or surrendered person or to the surviving
adult child, adult grandchild, or surviving spouse of
the deceased adopted or surrendered person and the
birth parent who filed the form shall be informed that
the relevant original birth certificate has already

been released.
(4) A copy of the original birth certificate shall
only be released to adopted or surrendered persons who
were born in Illinois; to surviving adult children,
adult grandchildren, or surviving spouses of deceased
adopted or surrendered persons who were born in
Illinois; or to 2 registered parties who have both
consented to the release of a non-certified copy of the
original birth certificate to one another through the
Registry when the birth of the relevant adopted or
surrendered person took place in Illinois.
(5) In cases where the Registry receives a Request
for a Non-Certified Copy of an Original Birth
Certificate from an adult adopted or surrendered
person who has not completed a Registry application and
the file of that adopted or surrendered person includes
an Information Exchange Authorization, Birth Parent
Preference Form, or Medical Information Exchange
Questionnaire from one or more of his or her birth
relatives, the Registry shall so inform the adult
adopted or surrendered person and forward Registry
application forms to him or her along with a
non-certified copy of the original birth certificate
consistent with the procedures outlined in this
subsection (e).
(6) In cases where a birth parent registered with

the Registry and filed a Medical Information Exchange
Questionnaire prior to the effective date of this
amendatory Act of the 96th General Assembly but gave no
indication as to his or her wishes regarding contact or
the sharing of identifying information, the Registry
shall contact the birth parent by written letter prior
to January 1, 2011, and provide him or her with the
opportunity to indicate his or her preference
regarding contact and the sharing of identifying
information by submitting a Birth Parent Preference
Form to the Registry prior to November 1, 2011.
(7) In cases where the Registry cannot locate a
copy of the original birth certificate in the Registry
file, they shall be authorized to request a copy of the
original birth certificate from the Illinois county
where the birth took place for placement in the
Registry file.
(8) Adopted and surrendered persons who wish to
have their names placed with the Illinois Adoption
Registry and Medical Information Exchange may do so by
completing a Registry application at any time, but
completing a Registry application shall not be
required for adopted and surrendered persons who seek
only to obtain a copy of their original birth
certificate or any relevant Birth Parent Preference
Forms through the Registry.

(9) In cases where a birth parent filed a Denial of
Information Exchange with the Registry prior to
January 1, 2011, or filed a Birth Parent Preference
Form with the Registry and selected Option E after
January 1, 2011, and a proof of death for the birth
parent who filed the Denial or the Birth Parent
Preference Form has been filed with the Registry by a
confidential intermediary, a surviving relative of the
deceased birth parent, or a birth child of the deceased
birth parent, the Registry shall be authorized to
release an unaltered non-certified copy of the
original birth certificate to an adult adopted or
surrendered person or to the surviving adult child,
adult grandchild, or surviving spouse of a deceased
adopted or surrendered person who has filed a Request
for a Non-Certified Copy of the Original Birth
Certificate with the Registry.
(10) On and after the effective date of this
amendatory Act of the 96th General Assembly, in cases
where all birth parents named on the original birth
certificate of an adopted or surrendered person born
after January 1, 1946, are deceased and copies of death
certificates for all birth parents named on the
original birth certificate have been filed with the
Registry by either a confidential intermediary, a
surviving relative of the deceased birth parent, or a

birth child of the deceased birth parent, the Registry
shall be authorized to release a non-certified copy of
the original birth certificate to the adopted or
surrendered person upon receipt of his or her Request
for a Non-Certified Copy of an Original Birth
Certificate.
(f) A registrant may complete all or any part of the
Illinois Adoption Registry Application. All Illinois
Adoption Registry Applications, Information Exchange
Authorizations, Denials of Information Exchange, requests
to revoke an Information Exchange Authorization or Denial
of Information Exchange, Birth Parent Preference Forms,
and affidavits submitted to the Registry shall be
accompanied by proof of identification.
(Source: P.A. 97-110, eff. 7-14-11; 97-333, eff. 8-12-11;
98-704, eff. 1-1-15.)
(750 ILCS 50/18.2) (from Ch. 40, par. 1522.2)
Sec. 18.2. Forms.
(a) The Department shall develop the Illinois Adoption
Registry forms as provided in this Section. The General
Assembly shall reexamine the content of the form as requested
by the Department, in consultation with the Registry Advisory
Council. The form of the Birth Parent Registration
Identification Form shall be substantially as follows:
BIRTH PARENT REGISTRATION IDENTIFICATION

(Insert all known information)
I, ....., state that I am the ...... (mother or father) of the
following child:
Child's original name: ..... (first) ..... (middle) .....
(last), ..... (hour of birth), ..... (date of birth),
..... (city and state of birth), ..... (name of
hospital).
Father's full name: ...... (first) ...... (middle) .....
(last), ..... (date of birth), ..... (city and state of
birth).
Name of mother inserted on birth certificate: ..... (first)
..... (middle) ..... (last), ..... (race), ..... (date
of birth), ...... (city and state of birth).
That I surrendered my child to: ............. (name of agency),
..... (city and state of agency), ..... (approximate date
child surrendered).
That I placed my child by private adoption: ..... (date),
...... (city and state).
Name of adoptive parents, if known: ......
Other identifying information: .....
........................
(Signature of parent)
............ ........................
(date) (printed name of parent)
(b) The form of the Adopted Person Registration

Identification shall be substantially as follows:
ADOPTED PERSON
REGISTRATION IDENTIFICATION
(Insert all known information)
I, ....., state the following:
Adopted Person's present name: ..... (first) .....
(middle) ..... (last).
Adopted Person's name at birth (if known): ..... (first)
..... (middle) ..... (last), ..... (birth date), .....
(city and state of birth), ...... (sex), ..... (race).
Name of adoptive father: ..... (first) ..... (middle) .....
(last), ..... (race).
Maiden name of adoptive mother: ..... (first) .....
(middle) ..... (last), ..... (race).
Name of birth mother (if known): ..... (first) .....
(middle) ..... (last), ..... (race).
Name of birth father (if known): ..... (first) .....
(middle) ..... (last), ..... (race).
Name(s) at birth of sibling(s) having a common birth parent
with adoptee (if known): ..... (first) ..... (middle)
..... (last), ..... (race), and name of common birth
parent: ..... (first) ..... (middle) ..... (last),
..... (race).
I was adopted through: ..... (name of agency).
I was adopted privately: ..... (state "yes" if known).
I was adopted in ..... (city and state), ..... (approximate

date).
Other identifying information: .............
......................
(signature of adoptee)
........... .........................
(date) (printed name of adoptee)
(c) The form of the Surrendered Person Registration
Identification shall be substantially as follows:
SURRENDERED PERSON REGISTRATION
IDENTIFICATION
(Insert all known information)
I, ....., state the following:
Surrendered Person's present name: ..... (first) .....
(middle) ..... (last).
Surrendered Person's name at birth (if known): .....
(first) ..... (middle) ..... (last), .....(birth
date), ..... (city and state of birth), ...... (sex),
..... (race).
Name of guardian father: ..... (first) ..... (middle) .....
(last), ..... (race).
Maiden name of guardian mother: ..... (first) .....
(middle) ..... (last), ..... (race).
Name of birth mother (if known): ..... (first) .....
(middle) ..... (last) ..... (race).
Name of birth father (if known): ..... (first) .....

(middle) ..... (last), .....(race).
Name(s) at birth of sibling(s) having a common birth parent
with surrendered person (if known): ..... (first)
..... (middle) ..... (last), ..... (race), and name of
common birth parent: ..... (first) ..... (middle)
..... (last), ..... (race).
I was surrendered for adoption to: ..... (name of agency).
I was surrendered for adoption in ..... (city and state), .....
(approximate date).
Other identifying information: ............
................................
(signature of surrendered person)
............ ......................
(date) (printed name of person
surrendered for adoption)
(c-3) The form of the Registration Identification Form for
Surviving Relatives of Deceased Birth Parents shall be
substantially as follows:
REGISTRATION IDENTIFICATION FORM
FOR SURVIVING RELATIVES OF DECEASED BIRTH PARENTS
(Insert all known information)
I, ....., state the following:
Name of deceased birth parent at time of surrender:
Deceased birth parent's date of birth:
Deceased birth parent's date of death:

Adopted or surrendered person's name at birth (if known):
.....(first) ..... (middle) ..... (last), .....(birth
date), ..... (city and state of birth), ...... (sex),
..... (race).
My relationship to the adopted or surrendered person (check
one): (birth parent's non-surrendered child) (birth parent's
parent) (birth parent's sister) (birth parent's brother).
If you are a non-surrendered child of the birth parent, provide
name(s) at birth and age(s) of non-surrendered siblings having
a common parent with the birth parent. If more than one
sibling, please give information requested below on reverse
side of this form. If you are a sibling or parent of the birth
parent, provide name(s) at birth and age(s) of the sibling(s)
of the birth parent. If more than one sibling, please give
information requested below on reverse side of this form.
Name (First) ..... (middle) ..... (last), .....(birth
date), ..... (city and state of birth), ...... (sex),
..... (race).
Name(s) of common parent(s) (first) ..... (middle) .....
(last), .....(race), (first) ..... (middle) .....
(last), .....(race).
My birth sibling/child of my brother/child of my sister/ was
surrendered for adoption to ..... (name of agency) City and
state of agency ..... Date .....(approximate) Other
identifying information ..... (Please note that you must: (i)

be at least 21 years of age to register; (ii) submit with your
registration a certified copy of the birth parent's birth
certificate; (iii) submit a certified copy of the birth
parent's death certificate; and (iv) if you are a
non-surrendered birth sibling or a sibling of the deceased
birth parent, also submit a certified copy of your birth
certificate with this registration. No application from a
surviving relative of a deceased birth parent can be accepted
if the birth parent filed a Denial of Information Exchange
prior to his or her death.)
................................
(signature of birth parent's surviving relative)
............ ............
(date) (printed name of birth
parent's surviving relative)
(c-5) The form of the Registration Identification Form for
Surviving Relatives of Deceased Adopted or Surrendered Persons
shall be substantially as follows:
REGISTRATION IDENTIFICATION FORM FOR
SURVIVING RELATIVES OF DECEASED ADOPTED OR SURRENDERED PERSONS
(Insert all known information)
I, ....., state the following:
Adopted or surrendered person's name at birth (if known):
(first) ..... (middle) ..... (last), .....(birth

date), ..... (city and state of birth), ...... (sex),
..... (race).
Adopted or surrendered person's date of death:
My relationship to the deceased adopted or surrendered
person(check one): (adoptive mother) (adoptive father) (adult
child) (surviving spouse).
If you are an adult child or surviving spouse of the adopted or
surrendered person, provide name(s) at birth and age(s) of the
children of the adopted or surrendered person. If the adopted
or surrendered person had more than one child, please give
information requested below on reverse side of this form.
Name (first) ..... (middle) ..... (last), .....(birth
date), ..... (city and state of birth), ...... (sex),
..... (race).
Name(s) of common parent(s) (first) ..... (middle) .....
(last), .....(race), (first) ..... (middle) .....
(last), .....(race).
My child/parent/deceased spouse was surrendered for
adoption to .....(name of agency) City and state of agency
..... Date ..... (approximate) Other identifying
information ..... (Please note that you must: (i) be at
least 21 years of age to register; (ii) submit with your
registration a certified copy of the adopted or surrendered
person's death certificate; (iii) if you are the child of a
deceased adopted or surrendered person, also submit a
certified copy of your birth certificate with this

registration; and (iv) if you are the surviving wife or
husband of a deceased adopted or surrendered person, also
submit a copy of your marriage certificate with this
registration. No application from a surviving relative of a
deceased adopted or surrendered person can be accepted if
the adopted or surrendered person filed a Denial of
Information Exchange prior to his or her death.)
................................
(signature of adopted or surrendered person's surviving
relative)
............ ............
(date) (printed name of adopted
person's surviving relative)
(d) The form of the Information Exchange Authorization
shall be substantially as follows:
INFORMATION EXCHANGE AUTHORIZATION
I, ....., state that I am the person who completed the
Registration Identification; that I am of the age of .....
years; that I hereby authorize the Department of Public Health
to give to the following person(s) (birth mother) (birth
father) (birth sibling) (adopted or surrendered person)
(adoptive mother) (adoptive father) (legal guardian of an
adopted or surrendered person) (birth grandparent) (birth

aunt) (birth uncle) (adult child of a deceased adopted or
surrendered person) (surviving spouse of a deceased adopted or
surrendered person) (all eligible relatives) the following
(please check the information authorized for exchange):
[ ] 1. Only my name and last known address.
[ ] 2. A copy of my Illinois Adoption Registry
Application.
[ ] 3. A non-certified copy of the adopted or
surrendered person's original certificate of live birth
(check only if you are an adopted or surrendered person or
the surviving adult child or surviving spouse of a deceased
adopted or surrendered person).
[ ] 4. A copy of my completed medical questionnaire.
I am fully aware that I can only be supplied with
information about an individual or individuals who have duly
executed an Information Exchange Authorization that has not
been revoked or, if I am an adopted or surrendered person, from
a birth parent who completed a Birth Parent Preference Form and
did not prohibit the release of his or her identity to me; that
I can be contacted by writing to: ..... (own name or name of
person to contact) (address) (phone number).
NOTE: New IARMIE registrants who do not complete a Medical
Information Exchange Questionnaire and release a copy of their
questionnaire to at least one Registry applicant must pay a $15
registration fee.
Dated (insert date).

..............
(signature)
(e) The form of the Denial of Information Exchange shall be
substantially as follows:
DENIAL OF INFORMATION EXCHANGE
I, ....., state that I am the person who completed the
Registration Identification; that I am of the age of .....
years; that I hereby instruct the Department of Public Health
not to give any identifying information about me to the
following person(s) (birth mother) (birth father) (birth
sibling) (adopted or surrendered person) (adoptive mother)
(adoptive father) (legal guardian of an adopted or surrendered
person) (birth grandparent) (birth aunt) (birth uncle) (adult
child of a deceased adopted or surrendered person) (surviving
spouse of a deceased adopted or surrendered person) (all
eligible relatives).
I do/do not (circle appropriate response) authorize the
Registry to release a copy of my completed Medical Information
Exchange Questionnaire to qualified Registry applicants. NOTE:
New IARMIE registrants who do not complete a Medical
Information Exchange Questionnaire and release a copy of their
questionnaire to at least one Registry applicant must pay a $15
registration fee. Birth parents filing a Denial of Information
Exchange are advised that, under Illinois law, an adult adopted
person may initiate a search for a birth parent who has filed a

Denial of Information Exchange or Birth Parent Preference Form
on which Option E was selected through the State confidential
intermediary program once 5 years have elapsed since the filing
of the Denial of Information Exchange or Birth Parent
Preference Form.
Dated (insert date).
...............
(signature)
(f) The form of the Birth Parent Preference Form shall be
substantially as follows:
In recognition of the basic right of all persons to access
their birth records, Illinois law now provides for the release
of original birth certificates to adopted and surrendered
persons 21 years of age or older upon request. While many birth
parents are comfortable sharing their identities or initiating
contact with their birth sons and daughters once they have
reached adulthood, Illinois law also recognizes that there may
be unique situations where a birth parent might have a
compelling reason for not wishing to establish contact with a
birth son or birth daughter or for not wishing to release
identifying information that appears on the original birth
certificate of a birth son or birth daughter who has reached
adulthood. The Illinois Adoption Registry and Medical
Information Exchange (IARMIE) has therefore established the
attached form to allow birth parents to express their

preferences regarding contact; and, if their birth child was
born on or after January 1, 1946, to express their wishes
regarding the sharing of identifying information listed on the
original birth certificate with an adult adopted or surrendered
person who has reached the age of 21 or his or her surviving
relatives.
In selecting one of the 5 options below, birth parents
should keep in mind that the decision to deny an adult adopted
or surrendered person access to identifying information on his
or her original birth record and/or information about
genetically-transmitted diseases is an important decision that
may impact the adopted or surrendered person's life in many
ways. A request for anonymity on this form only pertains to
information that is provided to an adult adopted or surrendered
person or his or her surviving relatives through the Registry.
This will not prevent the disclosure of identifying information
that may be available to the adoptee through his or her
adoptive parents and/or other means available to him or her.
Birth parents who would prefer not to be contacted by their
surrendered son or daughter are strongly urged to complete both
the Non-Identifying Information Section included on the final
page of the attached form and the Medical Questionnaire in
order to provide their surrendered son or daughter with the
background information he or she may need to better understand
his or her origins. Birth parents whose birth son or birth
daughter is under 21 years of age at the time of the completion

of this form are reminded that no original birth certificate
will be released by the IARMIE before an adoptee has reached
the age of 21. Should you need additional assistance in
completing this form, please contact the agency that handled
the adoption, if applicable, or the Illinois Adoption Registry
and Medical Information Exchange at 877-323-5299.
After careful consideration, I have made the following
decision regarding contact with my birth son/birth daughter,
(insert birth son's/birth daughter's name at birth, if
applicable) ......, who was born in (insert city/town of birth)
...... on (insert date of birth)...... and the release of my
identifying information as it appears on his/her original birth
certificate when he/she reaches the age of 21, and I have
chosen Option ...... (insert A, B, C, D, or E, as applicable).
I realize that this form must be accompanied by a completed
IARMIE application form as well as a Medical Information
Exchange Questionnaire or the $15 registration fee. I am also
aware that I may revoke this decision at any time by completing
a new Birth Parent Preference Form and filing it with the
IARMIE. I understand that it is my responsibility to update the
IARMIE with any changes to contact information provided below.
I also understand that, while preferences regarding the release
of identifying information through the Registry are binding
unless the law should change in the future, any selection I
have made regarding my preferred method of contact is not.
...

(Signature/Date)
(Please insert your signature and today's date above, as well
as under your chosen option, A, B, C, D, or E below.)
Option A. My birth son or birth daughter was born on or after
January 1, 1946, and I agree to the release of my identifying
information as it appears on my birth son's/birth daughter's
original birth certificate, OR my birth son or birth daughter
was born prior to January 1, 1946. I would welcome direct
contact with my birth son/birth daughter when he or she has
reached the age of 21. In addition, before my birth son or
birth daughter has reached the age of 21 or in the event of his
or her death, I would welcome contact with the following
relatives of my birth child (circle all that apply): adoptive
mother, adoptive father, surviving spouse, surviving adult
child. I wish to be contacted at the following mailing address,
email address or phone number:
..............................
.............................................................
.............................................................
.............................................................
(Signature/Date)
Option B. My birth son or birth daughter was born on or after
January 1, 1946, and I agree to the release of my identifying

information as it appears on my birth son's/birth daughter's
original birth certificate, OR my birth son or birth daughter
was born prior to January 1, 1946. I would welcome contact with
my birth son/birth daughter when he or she has reached the age
of 21. In addition, before my birth son or birth daughter has
reached the age of 21 or in the event of his or her death, I
would welcome contact with the following relatives of my birth
child (circle all that apply): adoptive mother, adoptive
father, surviving spouse, surviving adult child. I would prefer
to be contacted through the following person. (Insert name and
mailing address, email address or phone number of chosen
contact person.)
............................................
.............................................................
(Signature/Date)
Option C. My birth son or birth daughter was born on or after
January 1, 1946, and I agree to the release of my identifying
information as it appears on my birth son's/birth daughter's
original birth certificate, OR my birth son or birth daughter
was born prior to January 1, 1946. I would welcome contact with
my birth son/birth daughter when he or she has reached the age
of 21. In addition, before my birth son or birth daughter has
reached the age of 21 or in the event of his or her death, I
would welcome contact with the following relatives of my birth
child (circle all that apply): adoptive mother, adoptive

father, surviving spouse, surviving adult child. I would prefer
to be contacted through the Illinois Confidential Intermediary
Program (please call 800-526-9022 for additional information)
or through the agency that handled the adoption. (Insert agency
name, address and phone number, if applicable.)
.............
.............................................................
(Signature/Date)
Option D. My birth son or birth daughter was born on or after
January 1, 1946, and I agree to the release of my identifying
information as it appears on my birth son's/birth daughter's
original birth certificate when he or she has reached the age
of 21, OR my birth son or birth daughter was born prior to
January 1, 1946. I would prefer not to be contacted by my birth
son/birth daughter or his or her adoptive parents or surviving
relatives.
...................................................
(Signature/Date)
Option E. My birth son or birth daughter was born on or after
January 1, 1946, and I wish to prohibit the release of my
(circle ALL applicable options) first name, last name, last
known address, birth son/birth daughter's last name (if last
name listed is same as mine), as they appear on my birth
son's/birth daughter's original birth certificate and do not

wish to be contacted by my birth son/birth daughter when he or
she has reached the age of 21. If there were any special
circumstances that played a role in your decision to remain
anonymous which you would like to share with your birth
son/birth daughter, please list them in the space provided
below (optional).
...........................................
.............................................................
I understand that, although I have chosen to prohibit the
release of my identity on the non-certified copy of the
original birth certificate released to my birth son/birth
daughter, he or she may request that a court-appointed
confidential intermediary contact me to request updated
medical information and/or confirm my desire to remain
anonymous once 5 years have elapsed since the signing of this
form; at the time of this subsequent search, I wish to be
contacted through the person named below. (Insert in blank area
below the name and phone number of the contact person, or leave
it blank if you wish to be contacted directly.) I also
understand that this request for anonymity shall expire upon my
death.
......................................................
.............................................................
(Signature/Date)
NOTE: A copy of this form will be forwarded to your birth son

or birth daughter should he or she file a request for his or
her original birth certificate with the IARMIE. However, if you
have selected Option E, identifying information, per your
specifications above, will be deleted from the copy of this
form forwarded to your birth son or daughter during your
lifetime. In the event that an adopted or surrendered person is
deceased, his or her surviving adult children may request a
copy of the adopted or surrendered person's original birth
certificate providing they have registered with the IARMIE; the
copy of this form and the non-certified copy of the original
birth certificate forwarded to the surviving child of the
adopted or surrendered person shall be redacted per your
specifications on this form during your lifetime.
Non-Identifying Information Section
I wish to voluntarily provide the following non-identifying
information to my birth son or birth daughter:
My age at the time of my child's birth was .........
My race is best described as: ..........................
My height is: .........
My body type is best described as (circle one): slim, average,
muscular, a few extra pounds, or more than a few extra pounds.
My natural hair color is/was: ..................
My eye color is: ..................
My religion is best described as: ..................
My ethnic background is best described as: ..................
My educational level is closest to (circle applicable

response): completed elementary school, graduated from
high school, attended college, earned bachelor's degree,
earned master's degree, earned doctoral degree.
My occupation is best described as ..................
My hobbies include ..................
My interests include ..................
My talents include ..................
In addition to my surrendered son or daughter, I also
am the biological parent of (insert number) ....... boys and
(insert number) ....... girls, of whom (insert number) .......
are still living.
The relationship between me and my child's birth mother/birth
father would best be described as (circle appropriate
response): husband and wife, ex-spouses, boyfriend and
girlfriend, casual acquaintances, other (please specify)
..............
(g) The form of the Request for a Non-Certified Copy of an
Original Birth Certificate shall be substantially as follows:
REQUEST FOR A NON-CERTIFIED COPY OF AN ORIGINAL BIRTH
CERTIFICATE
I, (requesting party's full name) ....., hereby request a
non-certified copy of (check appropriate option) ..... my
original birth certificate ..... the original birth
certificate of my deceased adopted or surrendered parent .....
the original birth certificate of my deceased adopted or
surrendered spouse (insert deceased parent's/deceased spouse's

name at adoption) ...... I/my deceased parent/my deceased
spouse was born in (insert city and county of adopted or
surrendered person's birth) ..... on ..... (insert adopted or
surrendered person's date of birth). In the event that one or
both of my/my deceased parent's/my deceased spouse's birth
parents has requested that their identity not be released to
me/to my deceased parent/to my deceased spouse, I wish to
(check appropriate option) ..... a. receive a non-certified
copy of the original birth certificate from which identifying
information pertaining to the birth parent who requested
anonymity has been deleted; or ..... b. I do not wish to
receive received an altered copy of the original birth
certificate.
Dated (insert date).
...................
(signature)
(h) Any Information Exchange Authorization, Denial of
Information Exchange, or Birth Parent Preference Form filed
with the Registry, or Request for a Non-Certified Copy of an
Original Birth Certificate filed with the Registry by a
surviving adult child or surviving spouse of a deceased adopted
or surrendered person, shall be acknowledged by the person who
filed it before a notary public, in form substantially as
follows:
State of ..............

County of .............
I, a Notary Public, in and for the said County, in the
State aforesaid, do hereby certify that ...............
personally known to me to be the same person whose name is
subscribed to the foregoing certificate of acknowledgement,
appeared before me in person and acknowledged that (he or she)
signed such certificate as (his or her) free and voluntary act
and that the statements in such certificate are true.
Given under my hand and notarial seal on (insert date).
.........................
(signature)
(i) When the execution of an Information Exchange
Authorization, Denial of Information Exchange, or Birth Parent
Preference Form or Request for a Non-Certified Copy of an
Original Birth Certificate completed by a surviving adult child
or surviving spouse of a deceased adopted or surrendered person
is acknowledged before a representative of an agency, such
representative shall have his signature on said Certificate
acknowledged before a notary public, in form substantially as
follows:
State of..........
County of.........
I, a Notary Public, in and for the said County, in the
State aforesaid, do hereby certify that ..... personally known
to me to be the same person whose name is subscribed to the

foregoing certificate of acknowledgement, appeared before me
in person and acknowledged that (he or she) signed such
certificate as (his or her) free and voluntary act and that the
statements in such certificate are true.
Given under my hand and notarial seal on (insert date).
.......................
(signature)
(j) When an Illinois Adoption Registry Application,
Information Exchange Authorization, Denial of Information
Exchange, Birth Parent Preference Form, or Request for a
Non-Certified Copy of an Original Birth Certificate completed
by a surviving adult child or surviving spouse of a deceased
adopted or surrendered person is executed in a foreign country,
the execution of such document shall be acknowledged or
affirmed before an officer of the United States consular
services.
(k) If the person signing an Information Exchange
Authorization, Denial of Information, Birth Parent Preference
Form, or Request for a Non-Certified Copy of an Original Birth
Certificate completed by a surviving adult child or surviving
spouse of a deceased adopted or surrendered person is in the
military service of the United States, the execution of such
document may be acknowledged before a commissioned officer and
the signature of such officer on such certificate shall be
verified or acknowledged before a notary public or by such

other procedure as is then in effect for such division or
branch of the armed forces.
(l) An adopted or surrendered person, surviving adult
child, adult grandchild, surviving spouse, or birth parent of
an adult adopted person who completes a Request For a
Non-Certified Copy of the Original Birth Certificate shall meet
the same filing requirements and pay the same filing fees as a
non-adopted person seeking to obtain a copy of his or her
original birth certificate.
(m) Beginning on January 1, 2015, any birth parent of an
adult adopted person named on the original birth certificate
may request a non-certified copy of the original birth
certificate reflecting the birth of the adult adopted person,
provided that:
(1) any non-certified copy of the original birth
certificate released under this subsection (m) shall not
reflect the State file number on the original birth
certificate; and
(2) if the Department of Public Health does not locate
the original birth certificate, it shall issue a
certification of no record found.
(Source: P.A. 97-110, eff. 7-14-11; 98-704, eff. 1-1-15;
revised 12-10-14.)
(750 ILCS 50/18.3a) (from Ch. 40, par. 1522.3a)
Sec. 18.3a. Confidential intermediary.

(a) General purposes. Notwithstanding any other provision
of this Act,
(1) any adopted or surrendered person 21 years of age
or over; or
(2) any adoptive parent or legal guardian of an adopted
or surrendered person under the age of 21; or
(3) any birth parent of an adopted or surrendered
person who is 21 years of age or over; or
(4) any adult child or adult grandchild of a deceased
adopted or surrendered person; or
(5) any adoptive parent or surviving spouse of a
deceased adopted or surrendered person; or
(6) any adult birth sibling of the adult adopted or
surrendered person unless the birth parent has checked
Option E on the Birth Parent Preference Form or has filed a
Denial of Information Exchange with the Registry and is not
deceased; or
(7) any adult adopted birth sibling of an adult adopted
or surrendered person; or
(8) any adult birth sibling of the birth parent if the
birth parent is deceased; or
(9) any birth grandparent
may petition the court in any county in the State of Illinois
for appointment of a confidential intermediary as provided in
this Section for the purpose of exchanging medical information
with one or more mutually consenting biological relatives,

obtaining identifying information about one or more mutually
consenting biological relatives, or arranging contact with one
or more mutually consenting biological relatives. The
petitioner shall be required to accompany his or her petition
with proof of registration with the Illinois Adoption Registry
and Medical Information Exchange.
(b) Petition. Upon petition, the court shall appoint a
confidential intermediary. The petition shall indicate if the
petitioner wants to do any one or more of the following as to
the sought-after relative or relatives: exchange medical
information with the biological relative or relatives, obtain
identifying information from the biological relative or
relatives, or to arrange contact with the biological relative.
(c) Order. The order appointing the confidential
intermediary shall allow that intermediary to conduct a search
for the sought-after relative by accessing those records
described in subsection (g) of this Section.
(d) Fees and expenses. The court shall not condition the
appointment of the confidential intermediary on the payment of
the intermediary's fees and expenses in advance of the
commencement of the work of the confidential intermediary. No
fee shall be charged to any petitioner.
(e) Eligibility of intermediary. The court may appoint as
confidential intermediary any person certified by the
Department of Children and Family Services as qualified to
serve as a confidential intermediary. Certification shall be

dependent upon the confidential intermediary completing a
course of training including, but not limited to, applicable
federal and State privacy laws.
(f) (Blank).
(g) Confidential intermediary access to information.
Subject to the limitations of subsection (i) of this Section,
the confidential intermediary shall have access to vital
records maintained by the Department of Public Health and its
local designees for the maintenance of vital records, or a
comparable public entity that maintains vital records in
another state in accordance with that state's laws, and all
records of the court or any adoption agency, public or private,
as limited in this Section, which relate to the adoption or the
identity and location of an adopted or surrendered person, of
an adult child or surviving spouse of a deceased adopted or
surrendered person, or of a birth parent, birth sibling, or the
sibling of a deceased birth parent. The confidential
intermediary shall not have access to any personal health
information protected by the Standards for Privacy of
Individually Identifiable Health Information adopted by the
U.S. Department of Health and Human Services under the Health
Insurance Portability and Accountability Act of 1996 unless the
confidential intermediary has obtained written consent from
the person whose information is being sought by an adult
adopted or surrendered person or, if that person is a minor
child, that person's parent or guardian. Confidential

intermediaries shall be authorized to inspect confidential
relinquishment and adoption records. The confidential
intermediary shall not be authorized to access medical records,
financial records, credit records, banking records, home
studies, attorney file records, or other personal records. In
cases where a birth parent is being sought, an adoption agency
shall inform the confidential intermediary of any statement
filed pursuant to Section 18.3, hereinafter referred to as "the
18.3 statement", indicating a desire of the surrendering birth
parent to have identifying information shared or to not have
identifying information shared. Information provided to the
confidential intermediary by an adoption agency shall be
restricted to the full name, date of birth, place of birth,
last known address, last known telephone number of the
sought-after relative or, if applicable, of the children or
siblings of the sought-after relative, and the 18.3 statement.
If the petitioner is an adult adopted or surrendered person or
the adoptive parent of a minor and if the petitioner has signed
a written authorization to disclose personal medical
information, an adoption agency disclosing information to a
confidential intermediary shall disclose available medical
information about the adopted or surrendered person from birth
through adoption.
(h) Missing or lost original birth certificate; remedy.
Disclosure of information by the confidential intermediary
shall be consistent with the public policy and intent of laws

granting original birth certificate access as expressed in
Section 18.04 of this Act. The confidential intermediary shall
comply with the following procedures in disclosing information
to the petitioners:
(1) If the petitioner is an adult adopted or
surrendered person, or the adult child, adult grandchild,
or surviving spouse of a deceased adopted or surrendered
person, the confidential intermediary shall disclose:
(A) identifying information about the birth parent
of the adopted person which, in the ordinary course of
business, would have been reflected on the original
filed certificate of birth, as of the date of birth,
only if:
(i) the adopted person was born before January
1, 1946 and the petitioner has requested a
non-certified copy of the adopted person's
original birth certificate under Section 18.1 of
this Act, and the Illinois Department of Public
Health has issued a certification that the
original birth certificate was not found, or the
petitioner has presented the confidential
intermediary with the non-certified copy of the
original birth certificate which omits the name of
the birth parent;
(ii) the adopted person was born after January
1, 1946, and the petitioner has requested a

non-certified copy of the adopted person's
original birth certificate under Section 18.1 of
this Act and the Illinois Department of Public
Health has issued a certification that the
original birth certificate was not found.
In providing information pursuant to this
subdivision (h)(1)(A), the confidential intermediary
shall expressly inform the petitioner in writing that
since the identifying information is not from an
official original certificate of birth filed pursuant
to the Vital Records Act, the confidential
intermediary cannot attest to the complete accuracy of
the information and the confidential intermediary
shall not be liable if the information disclosed is not
accurate. Only information from the court files shall
be provided to the petitioner in this Section. If the
identifying information concerning a birth father is
sought by the petitioner, the confidential
intermediary shall disclose only the identifying
information of the birth father as defined in Section
18.06 of this Act;
(B) the name of the child welfare agency which had
legal custody of the surrendered person or
responsibility for placing the surrendered person and
any available contact information for such agency;
(C) the name of the state in which the surrender

occurred or in which the adoption was finalized; and
(D) any information for which the sought-after
relative has provided his or her consent to disclose
under paragraphs (1) through (4) of subsection (i) of
this Section.
(2) If the petitioner is an adult adopted or
surrendered person, or the adoptive parent of an adult
adopted or surrendered person under the age of 21, or the
adoptive parent of a deceased adopted or surrendered
person, the confidential intermediary shall provide, in
addition to the information listed in paragraph (1) of this
subsection (h):
(A) any information which the adoption agency
provides pursuant to subsection (i) of this Section
pertaining to medical information about the adopted or
surrendered person; and
(B) any non-identifying information, as defined in
Section 18.4 of this Act, that is obtained during the
search.
(3) If the petitioner is not defined in paragraph (1)
or (2) of this subsection, the confidential intermediary
shall provide to the petitioner:
(A) any information for which the sought-after
relative has provided his or her consent under
paragraphs (1) through (4) of subsection (i) of this
Section;

(B) the name of the child welfare agency which had
legal custody of the surrendered person or
responsibility for placing the surrendered person and
any available contact information for such agency; and
(C) the name of the state in which the surrender
occurred or in which the adoption was finalized.
(h-5) Disclosure of information shall be made by the
confidential intermediary at any time from the appointment of
the confidential intermediary and the court's issuance of an
order of dismissal.
(i) Duties of confidential intermediary in conducting a
search. In conducting a search under this Section, the
confidential intermediary shall first determine whether there
is a Denial of Information Exchange or a Birth Parent
Preference Form with Option E selected or an 18.3 statement
referenced in subsection (g) of this Section on file with the
Illinois Adoption Registry. If there is a denial, the Birth
Parent Preference Form on file with the Registry and the birth
parent who completed the form selected Option E, or if there is
an 18.3 statement indicating the birth parent's intent not to
have identifying information shared and the birth parent did
not later file an Information Exchange Authorization with the
Registry, the confidential intermediary must discontinue the
search unless 5 years or more have elapsed since the execution
of the Denial of Information Exchange, Birth Parent Preference
Form, or the 18.3 statement. If a birth parent was previously

the subject of a search through the State confidential
intermediary program, the confidential intermediary shall
inform the petitioner of the need to discontinue the search
until 10 years or more have elapsed since the initial search
was closed. In cases where a birth parent has been the object
of 2 searches through the State confidential intermediary
program, no subsequent search for the birth parent shall be
authorized absent a court order to the contrary.
In conducting a search under this Section, the confidential
intermediary shall attempt to locate the relative or relatives
from whom the petitioner has requested information. If the
sought-after relative is deceased or cannot be located after a
diligent search, the confidential intermediary may contact
other adult relatives of the sought-after relative.
The confidential intermediary shall contact a sought-after
relative on behalf of the petitioner in a manner that respects
the sought-after relative's privacy and shall inform the
sought-after relative of the petitioner's request for medical
information, identifying information or contact as stated in
the petition. Based upon the terms of the petitioner's request,
the confidential intermediary shall contact a sought-after
relative on behalf of the petitioner and inform the
sought-after relative of the following options:
(1) The sought-after relative may totally reject one or
all of the requests for medical information, identifying
information or contact. The sought-after relative shall be

informed that they can provide a medical questionnaire to
be forwarded to the petitioner without releasing any
identifying information. The confidential intermediary
shall inform the petitioner of the sought-after relative's
decision to reject the sharing of information or contact.
(2) The sought-after relative may consent to
completing a medical questionnaire only. In this case, the
confidential intermediary shall provide the questionnaire
and ask the sought-after relative to complete it. The
confidential intermediary shall forward the completed
questionnaire to the petitioner and inform the petitioner
of the sought-after relative's desire to not provide any
additional information.
(3) The sought-after relative may communicate with the
petitioner without having his or her identity disclosed. In
this case, the confidential intermediary shall arrange the
desired communication in a manner that protects the
identity of the sought-after relative. The confidential
intermediary shall inform the petitioner of the
sought-after relative's decision to communicate but not
disclose his or her identity.
(4) The sought-after relative may consent to initiate
contact with the petitioner. The confidential intermediary
shall obtain written consents from both parties that they
wish to disclose their identities to each other and to have
contact with each other.

(j) Oath. The confidential intermediary shall sign an oath
of confidentiality substantially as follows: "I, ..........,
being duly sworn, on oath depose and say: As a condition of
appointment as a confidential intermediary, I affirm that:
(1) I will not disclose to the petitioner, directly or
indirectly, any confidential information except in a
manner consistent with the law.
(2) I recognize that violation of this oath subjects me
to civil liability and to a potential finding of contempt
of court. ................................
SUBSCRIBED AND SWORN to before me, a Notary Public, on (insert
date)
................................."
(k) Sanctions.
(1) Any confidential intermediary who improperly
discloses confidential information identifying a
sought-after relative shall be liable to the sought-after
relative for damages and may also be found in contempt of
court.
(2) Any person who learns a sought-after relative's
identity, directly or indirectly, through the use of
procedures provided in this Section and who improperly
discloses information identifying the sought-after
relative shall be liable to the sought-after relative for
actual damages plus minimum punitive damages of $10,000.
(3) The Department shall fine any confidential

intermediary who improperly discloses confidential
information in violation of item (1) or (2) of this
subsection (k) an amount up to $2,000 per improper
disclosure. This fine does not affect civil liability under
item (2) of this subsection (k). The Department shall
deposit all fines and penalties collected under this
Section into the Illinois Adoption Registry and Medical
Information Fund.
(l) Death of person being sought. Notwithstanding any other
provision of this Act, if the confidential intermediary
discovers that the person being sought has died, he or she
shall report this fact to the court, along with a copy of the
death certificate. If the sought-after relative is a birth
parent, the confidential intermediary shall also forward a copy
of the birth parent's death certificate, if available, to the
Registry for inclusion in the Registry file.
(m) Any confidential information obtained by the
confidential intermediary during the course of his or her
search shall be kept strictly confidential and shall be used
for the purpose of arranging contact between the petitioner and
the sought-after birth relative. At the time the case is
closed, all identifying information shall be returned to the
court for inclusion in the impounded adoption file.
(n) (Blank).
(o) Except as provided in subsection (k) of this Section,
no liability shall accrue to the State, any State agency, any

judge, any officer or employee of the court, any certified
confidential intermediary, or any agency designated to oversee
confidential intermediary services for acts, omissions, or
efforts made in good faith within the scope of this Section.
(p) An adoption agency that has received a request from a
confidential intermediary for the full name, date of birth,
last known address, or last known telephone number of a
sought-after relative pursuant to subsection (g) of Section
18.3a, or for medical information regarding a sought-after
relative pursuant to subsection (h) of Section 18.3a, must
satisfactorily comply with this court order within a period of
45 days. The court shall order the adoption agency to reimburse
the petitioner in an amount equal to all payments made by the
petitioner to the confidential intermediary, and the adoption
agency shall be subject to a civil monetary penalty of $1,000
to be paid to the Department of Children and Family Services.
Following the issuance of a court order finding that the
adoption agency has not complied with Section 18.3, the
adoption agency shall be subject to a monetary penalty of $500
per day for each subsequent day of non-compliance. Proceeds
from such fines shall be utilized by the Department of Children
and Family Services to subsidize the fees of petitioners as
referenced in subsection (d) of this Section.
(q) (Blank).
Any reimbursements and fines, notwithstanding any
reimbursement directly to the petitioner, paid under this

subsection are in addition to other remedies a court may
otherwise impose by law.
The Department of Children and Family Services shall submit
reports to the Adoption Registry-Confidential Intermediary
Advisory Council by July 1 and January 1 of each year in order
to report the penalties assessed and collected under this
subsection, the amounts of related deposits into the DCFS
Children's Services Fund, and any expenditures from such
deposits.
(Source: P.A. 97-110, eff. 7-14-11; 97-1063, eff. 1-1-13;
98-704, eff. 1-1-15.)
(750 ILCS 50/18.6) (from Ch. 40, par. 1522.6)
Sec. 18.6. Registry fees. The Department of Public Health
shall levy a fee for each registrant under Sections 18.05
through 18.5. A $15 fee shall be charged for registering with
the Illinois Adoption Registry and Medical Information
Exchange. However, this fee shall be waived for all adopted or
surrendered persons, surviving children and spouses of
deceased adopted persons, adoptive parents, legal guardians,
birth parents, birth grandparents, birth aunts, birth uncles,
and birth siblings who complete a Medical Information Exchange
Questionnaire at the time of registration and authorize its
release to specified registered parties, and for adoptive
parents registering within 12 months of the finalization of the
adoption. All persons who were registered with the Illinois

Adoption Registry prior to the effective date of this
amendatory Act of 1999 and who wish to update their
registration may do so without charge. No charge of any kind
shall be made for the withdrawal of any form provided in
Section 18.2.
(Source: P.A. 96-895, eff. 5-21-10; 97-110, eff. 7-14-11.)