Certification letter form

(410 ILCS 535/25.7)     Sec. 25.7. Certification letter form. In order to seek a waiver of the fee for a copy of a vital record, the person seeking the record must provide the following certification letter:  Certification Letter for Domestic Violence Waiver for Illinois Vital Records Full Name of Applicant:............................... Date of Birth:........................................     I,........................, certify, to the best of my knowledge and belief, that on the date listed below, the above named individual is a victim or child of a victim of domestic violence, as defined by Section 103 of the Illinois Domestic Violence Act of 1986 (750 ILCS 60/103), who is currently fleeing a dangerous living situation. I provide this certification in my capacity as (check one below):         ( ) an advocate at a family violence center who     assisted the victim;        ( ) a licensed medical care or mental health provider;         ( ) the director of an emergency shelter or     transitional housing; or         ( ) the director of a transitional living program. Signature:................. Date:........................  Title:..................... Employer:....................  Email:..................... Phone:.......................  Address:................... City:........................  State:..................... Zip:.........................  (Source: P.A. 103-170, eff. 1-1-24; 103-605, eff. 7-1-24.)