Illinois Affidavit and Certificate of Correction Request for a Death Record (VR 400)
Official state formCorrections and amendmentsForm VR 400Free downloadLast verified November 10, 2026
Notarized affidavit asking the Illinois Department of Public Health to correct a death record or a fetal death record. The applicant lists what is wrong on the record and how it should read.
Who can use this form
- The applicant states their relationship to the person named on the record.
- The form gives examples such as mother, son or funeral director.
What to send with it
- The completed affidavit, signed in front of a notary. The notarization date must match the signing date.
- A copy of a valid, non-expired government-issued photo ID.
- Documents that support the correction, or a court order when documents do not support the change.
Where to send it
- Mail to
- See the form for where to file it.
- State fee
- $15 for the first copy and $2 for each additional copy requested at the same time, per the office's fee schedule. The fee could not be read from the form itself.
- Typical processing
- Approximately 12 weeks from receipt for mailed requests, per the notice on the office's records pages. Urgent overnight requests with proof of need: 15 business days for a correction.
- Form revision
- Rev. 08/26
- Source
- Official government page