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Certification of vital record.

I certify that this child was born alive at the place and time and on the date stated.
I certify that the personal information provided on this certificate is correct to the best of my knowledge and belief.
this is to certify that this is a true and correct copy from the official record filed with the illinois department of health.
Any alteration or erasure voids this certificate.

Certifier attendant :

Attendant's mailing address :