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PLC:a0000a
Agency:Randolph County Clerk
For:Birth Certificates
Phone:618-826-5000 191

Address:1 Taylor Street
Chester, Illinois 62233

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*Required Fields

FAX 618-826-3750 or EMAIL countyclerk@randolphcountyil.gov a copy of your photo I.D. Your request will NOT be completed until your photocopy is received

*Full Name on Certificate First:
Full Name on Certificate Middle:
*Full Name on Certificate Last:
*Date of Birth: (mm/dd/yyyy)
*City/Town of Birth:
*Relationship to Certificate Holder:
*Mother's Full (Maiden) Name:
*Father's Full Name:
Other Relationship:
*Intended Use of Document:
*# of Certificates ( $15 per certificate/copy):
*Email Address:

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