This required section statesthe names and addresses of theperson requesting thebirth/death certificate andthe contact person in thevital statistics office.Press [Ctrl+F1] for moreinformation.
REQUIRED TRANSFER SECTIONCount Field 1 1TODATE
REQUIRED CERTIFICATE SECTION (SECTION 1 OF 1) [Optional - From Address]
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Re: Request for Birth Certificate Request for Death Certificate :
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This required section states the names and addresses of theperson requesting the birth/death certificate and the contactperson at the Vital Statistics Office. Access the Expert Guide formore information.Enter an X to include the name and address of the person requestingthe birth/death certificate.Enter the name of the person (the Requestor) to whom the birth/deathcertificate should be sent. Press [F2] to select and paste a recordfrom the Address Manager.Enter the Requestor's street address or edit the information asdesired.Enter the Requestor's extended street address or edit theinformation as desired.Enter the Requestor's city or edit the information as desired.Enter the Requestor's state/province or edit the information asdesired. Press [F8] to select a state from the selection box.Enter the Requestor's zip/postal code or edit the information asdesired.Enter an X to include the country in which the Requestor is located,if outside the United States.Enter the country in which the Requestor is located or edit theinformation as desired.Using the format MM/DD/YYYY, enter the date of the letter or editthe information as desired.If known, enter the personal title and name of the contact person atthe Vital Statistics Office. Press [F2] to select and paste arecord from the Address Manager.If known, enter the contact person's employment title or edit theinformation as desired.Enter the name of the office from which vital statistic recordsare requested. Press [F2] to select and paste a record from theAddress Manager. Access the Expert Guide for more information.Enter the office's street address or edit the information asdesired.Enter the office's extended street address or edit the informationas desired.Enter the city in which the office is located or edit theinformation as desired.Enter the state/province in which the office is located or editthe information as desired. Press [F8] to select a state from theselection box.Enter the office's zip/postal code or edit the information asdesired.Enter an X to include the country in which the office is located,if outside the United States.Enter the country in which the office is located or edit theinformation as desired.Enter an X if this is a request to obtain a BIRTH certificate.Access the Expert Guide for more information.Enter an X if this is a request to obtain a DEATH certificate.Access the Expert Guide for more information.Enter a salutation or edit the information as desired. Press [F8]to select a salutation from the selection box. NOTE: If thesalutation or the following name field is blank, it will not beprinted.The program completes the contact person's personal title and nameby transferring the information from a previous field. The name maybe changed without affecting earlier data.
Dear
CONTINUED REQUIRED CERTIFICATE SECTION - BIRTH (SECTION 1 OF 1) Please forward to my attention certified copy/copies of the birth certificate for the following person: Full name: Sex: To assist in locating and providing the requested certificate(s), I am providing the following information: Father's full name: Mother's full name: Mother's maiden name: Date of birth: Place of birth: City: County: State: Hospital or other location: This certificate is being requested I am the person the of the person whose record is being requested. Enclosed is my certified check my money order my personal check in the amount of $ as payment for the requested certificate(s). If you have any questions or need additional information, please contact me at the above address. I can also be contacted by phone at extension or extension . A fax can be sent to . Thank you for your prompt attention to this matter. [Optional enclosure and carbon copy lines]
This required section provides information to assist in locatingthe birth certificate and the reason why the certificate is beingrequested. Access the Expert Guide for more information.Enter the number of copies of birth certificates requested.Enter the full name of the person whose birth certificate is beingrequested.Enter the sex of the person or press [F8] to select "Male" or"Female" from the selection box.Enter the full name of the person's father. If the information isnot known enter "Unknown".Enter the full name of the person's mother. If the information isnot known enter "Unknown".Enter the maiden name (last name only) of the person's mother. Ifthe information is not known enter "Unknown".Enter an X to include the date the birth.Using the format MM/DD/YYYY, enter the person's date of birth.Enter an X to include the person's place of birth.Enter the city of birth.Enter the "county" of birth (for example, "Linn County"). If thecounty is not known, enter "County unknown".Enter the state/province of birth. Press [F8] to select a statefrom the selection box. If the state of birth is not known, enter"State unknown".Enter the name of the hospital or other location where the personwas born, if known.Enter the reason the certificate is being requested (for example,for a passport application or Social Security benefits).Enter an X if you are the person whose birth certificate is beingrequested.Enter an X if you are not the person whose birth certificate isbeing requested.Enter YOUR relationship to the person whose birth certificate isbeing requested (for example, parent, or child). Press [F8] toselect a relationship from the selection box.Enter an X if payment is being made by CERTIFIED CHECK. Access theExpert Guide for more information.Enter an X if payment is being made by MONEY ORDER. Access theExpert Guide for more information.Enter an X if payment is being made by PERSONAL CHECK. Access theExpert Guide for more information.Enter an X if payment is being made by ANOTHER METHOD. Access theExpert Guide for more information.Enter the method by which payment will be made.Enter the dollar amount of the fee required for the requestedcertificate(s). Access the Expert Guide for more information.Enter an X to request that you be contacted by mail at the aboveaddress.Enter an X to include phone numbers where you can be reached.Enter an X to include a phone number at which you can be reachedduring non-business hours.Enter a non-business phone number or edit the information asdesired.Enter an X to include a phone extension number.Enter a phone extension number or edit the information as desired.Enter an X to include a phone number at which you can be reachedduring business hours.Enter a business phone number or edit the information as desired.Enter an X to include a phone extension number.Enter a phone extension number or edit the information as desired.Enter an X to include a facsimile number.Enter a facsimile number or edit the information as desired.Enter a closing or edit the information as desired. Press [F8] toselect another closing from the selection box.The program completes the name of the Requestor by transferring theinformation from a previous section. The name can be changedwithout affecting earlier data.Enter an X to include a listing of attachments, enclosures, orpersons to whom copies of the letter are being sent.Use this space to enter information regarding enclosures or copiesor press [F8] to select a description from the selection box. Forexample, "Enclosures" or "Copy To".Use this space to enter corresponding information. For example, adescription of the enclosure(s) or the name of a party receiving acopy.
Sincerely, -
-+*)'%#!
CONTINUED REQUIRED CERTIFICATE SECTION - DEATH (SECTION 1 OF 1) Please forward to my attention certified copy/copies of the death certificate for the following person: Full name: Sex: To assist in locating and providing the requested certificate(s), I am providing the following information: Father's full name: Mother's full name: Mother's maiden name: Date of death: Place of death: City: County: State: Hospital or other location: This certificate is being requested I am the of the person whose record is being requested. Enclosed is my certified check my money order my personal check in the amount of $ as payment for the requested certificate(s). If you have any questions or need additional information, please contact me at the above address. I can also be contacted by phone at extension or extension . A fax can be sent to . Thank you for your prompt attention to this matter. [Optional enclosure and carbon copy lines]
This required section provides information to assist in locatingthe death certificate and the reason why the certificate is beingrequested. Access the Expert Guide for more information.Enter the number of copies of death certificates requested.Enter the full name of the person whose death certificate is beingrequested.Enter the sex of the person or press [F8] to select "Male" or"Female" from the selection box.Enter the full name of the decedent's father. If the information isnot known enter "Unknown".Enter the full name of the decedent's mother. If the information isnot known enter "Unknown".Enter the maiden name (last name only) of the decedent's mother. Ifthe information is not known enter "Unknown".Enter an X to include the date of death.Using the format MM/DD/YYYY, enter the person's date of death.Enter an X to include the person's place of death.Enter the city where the decedent died.Enter "county" or "parish" where the decedent died (for example,"Linn County"). If county is not known, enter "County unknown."Enter the state/province of death. Press [F8] to select a statefrom the selection box. If the state of death is not known, enter"State unknown".Enter the name of the hospital or other location where the decedentdied (for example, at home).Describe the purpose for which the death certificate is needed (forexample, for application for Social Security benefits or toaccomplish the transfer of an asset owned by the decedent to anotherperson).Enter YOUR relationship to the person whose death certificate isbeing requested (for example, parent, or child). Press [F8] toselect a relationship from the selection box.Enter an X if payment is being made by CERTIFIED CHECK. Access theExpert Guide for more information.Enter an X if payment is being made by MONEY ORDER. Access theExpert Guide for more information.Enter an X if payment is being made by PERSONAL CHECK. Access theExpert Guide for more information.Enter an X if payment is being made by ANOTHER METHOD. Access theExpert Guide for more information.Enter the method by which payment will be made.Enter the dollar amount of the fee required for the requestedcertificate(s). Access the Expert Guide for more information.Enter an X to request that you be contacted by mail at the aboveaddress.Enter an X to include phone numbers where you can be reached.Enter an X to include a phone number at which you can be reachedduring non-business hours.Enter a non-business phone number or edit the information asdesired.Enter an X to include a phone extension number.Enter a phone extension number or edit the information as desired.Enter an X to include a phone number at which you can be reachedduring business hours.Enter a business phone number or edit the information as desired.Enter an X to include a phone extension number.Enter a phone extension number or edit the information as desired.Enter an X to include a facsimile number.Enter a facsimile number or edit the information as desired.Enter a closing or edit the information as desired. Press [F8] toselect another closing from the selection box.The program completes the name of the Requestor by transferring theinformation from a previous section. The name can be changedwithout affecting earlier data.Enter an X to include a listing of attachments, enclosures, orpersons to whom copies of the letter are being sent.Use this space to enter information regarding enclosures or copiesor press [F8] to select a description from the selection box. Forexample, "Enclosures" or "Copy To".Use this space to enter corresponding information. For example, adescription of the enclosure(s) or the name of a party receiving acopy.
Sincerely, ,
+)('%#!
ADDR3
TOADDR
Request for Birth Certificate
Request for Death Certificate
Please forward to my attention
certified copy/copies of the
birth certificate for the following person:
Full name:
To assist in locating and providing the requested certificate(s), I am
providing the following information:
Father's full name:
Mother's full name:
Mother's maiden name:
Date of birth:
Place of birth:
City:
County:
State:
Hospital or other location:
This certificate is being requested
BFREE6
the person
of the person
whose record is being requested.
Enclosed is
my certified check
my money order
my personal check
in the amount of
as payment for the requested
certificate(s).
If you have any questions or need additional information, please
contact me at the above address.
I can also be contacted by phone at
, extension
, extension
A fax can be sent to me at
Thank you for your prompt attention to this matter.
BDCERT02
BDCERT02
BDCERT02
BDCERT02
BDCERT02
BDCERT02
BDCERT02
BDCERT02
Please forward to my attention
certified copy/copies of the
death certificate for the following person:
Full name:
To assist in locating and providing the requested certificate(s), I am
providing the following information:
Father's full name:
Mother's full name:
Mother's maiden name:
Date of death:
Place of death:
City:
County:
State:
Hospital or other location:
This certificate is being requested
BFREE6
I am the
of the person whose record is being
requested.
Enclosed is
my certified check
my money order
my personal check
in the amount of
as payment for the requested
certificate(s).
If you have any questions or need additional information, please
contact me at the above address.
I can also be contacted by phone at
, extension
, extension
A fax can be sent to me at
Thank you for your prompt attention to this matter.
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