Birth Record Request Form - A3

Birth records free of charge for verified homeless, domestic violence victims, and formerly incarcerated individuals

A free birth record is available to persons born in Cook County who are verified as either: homeless, residents of shelters for victims of domestic abuse/violence, and/or formerly incarcerated (released in the last 90 days) or soon to be released inmates and detainees from IDOC or Cook County Jail.

Verification from a parole release form or a status certification form completed by a qualified human services staff is required. An individual cannot submit a form without proper verification from an approved human services provider.

Click here to download a Free Birth Record Request Form and Status Certification

  • Request form must be completely filled out and signed by the verifying agent.
  • No handwritten forms accepted. Fillable forms available here.
  • Photocopies will not be accepted. Forms are available online here.
  • Requests for A-3 forms are may only be submitted by mail or in-person at one of our six offices.
  • The Clerk's Office can provide only 4 free of charge birth records annually to a homeless person.

Anyone who knowingly or purposefully falsifies this verification is subject to a penalty of $100. (410 ILCS 535/25.3)