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Illinois Surrogate Parentage Certification: Gestational Surrogate (VR 810.1)

Official state formParentage and paternityForm VR 810.1Free downloadLast verified November 10, 2026

Certified statement signed by the gestational surrogate before the birth of a child carried by a gestational surrogate, so the intended parents are entered on the birth certificate. A photocopy is filed with the Illinois Department of Public Health.

Who can use this form

  • The gestational surrogate.
  • Used when a child is carried by a gestational surrogate under the Gestational Surrogacy Act.

What to send with it

  • The statement, signed before two competent adult witnesses who are not parties to the arrangement.
  • It must be signed before the birth.
  • The original goes to the hospital of planned delivery. A photocopy is filed with the Illinois Department of Public Health.
  • It is one of six statements required under the Gestational Surrogacy Act.

Where to send it

Mail to
Illinois Department of Public Health 110 West Lawrence Ave. Springfield, Illinois 62704-2610
State fee
No charge to file surrogate parentage statements.
Typical processing
Not provided
Form revision
08/26
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Illinois Surrogate Parentage Certification: Gestational Surrogate (VR 810.1) | Illinois Form