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    Missouri Death Certificates PDF

    Uploaded by

    Nurettin Turan
    This document is an application for a certified copy of a birth or death certificate from the Missouri Department of Health and Senior Services. It outlines the required fees for searching for and obtaining certified copies of birth and death records based on the year being searched. The application requests information to identify the specific birth or death record being requested such as the name, date, place, and parents' names. It notes that certified copies are computer-generated and valid for all legal purposes.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Missouri Death Certificates PDF

    Uploaded by

    Nurettin Turan
    345 views1 page
    This document is an application for a certified copy of a birth or death certificate from the Missouri Department of Health and Senior Services. It outlines the required fees for searching for and obtaining certified copies of birth and death records based on the year being searched. The application requests information to identify the specific birth or death record being requested such as the name, date, place, and parents' names. It notes that certified copies are computer-generated and valid for all legal purposes.

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    This document is an application for a certified copy of a birth or death certificate from the Missouri Department of Health and Senior Services. It outlines the required fees for searching for and obtaining certified copies of birth and death records based on the year being searched. The application requests information to identify the specific birth or death record being requested such as the name, date, place, and parents' names. It notes that certified copies are computer-generated and valid for all legal purposes.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    345 views1 page

    Missouri Death Certificates PDF

    Uploaded by

    Nurettin Turan
    This document is an application for a certified copy of a birth or death certificate from the Missouri Department of Health and Senior Services. It outlines the required fees for searching for and obtaining certified copies of birth and death records based on the year being searched. The application requests information to identify the specific birth or death record being requested such as the name, date, place, and parents' names. It notes that certified copies are computer-generated and valid for all legal purposes.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    MISSOURI DEPARTMENT OF HEALTH AND SENIOR SERVICES P.O.

    BOX 570
    BUREAU OF VITAL RECORDS JEFFERSON CITY, MISSOURI 65102-0570
    APPLICATION FOR COPY OF BIRTH OR DEATH CERTIFICATION

    Missouri law requires a fee for a search of the files. Applicant will receive one (1) certified copy if record is
    found. If no record is found, the fee is retained for the search. A statement will be issued if no record is found.
    **Certified copies are computer generated and are valid for all legal purposes.
    FEE MUST ACCOMPANY APPLICATION
    Check or money order payable to: Missouri Department of Health and Senior Services
    Statewide recording of birth and death records began January 1, 1910

    TYPE OR PRINT ALL ITEMS EXCEPT SIGNATURES

    BIRTH ________ (Quantity) DEATH ________ (Quantity)


    A $15.00 fee is required for each five (5) year search of the files A $13.00 fee is required for each five (5) year search of the files
    for a birth certificate. If the record is found, one (1) certified copy for a death certificate. If the record is found, one (1) certified
    will be provided. There is a $15.00 fee for each additional copy copy will be provided. There is a $10.00 fee for each additional
    of the same record. copy of the same record ordered at the same time.

    NAME ON CERTIFICATE (FIRST) (MIDDLE) (LAST) NAME ON CERTIFICATE (FIRST) (MIDDLE) (LAST)

    ALSO KNOWN AS (INDICATE IF BIRTH COULD BE RECORDED UNDER ANOTHER NAME) PLACE OF DEATH (CITY) (COUNTY) SEX

    DATE OF BIRTH (MONTH) (DAY) (YEAR) DATE OF DEATH (MONTH) (DAY) (YEAR) RACE

    PLACE OF BIRTH (CITY) (COUNTY) (STATE) DATE OF BIRTH AGE SS# (IF KNOWN)

    HOSPITAL SEX RACE SPOUSE’S NAME (FIRST) (MIDDLE) (LAST)

    FATHER’S NAME (FIRST) (MIDDLE) (LAST) FATHER’S NAME (FIRST) (MIDDLE) (LAST)

    MOTHER’S NAME (FIRST) (MIDDLE) (MAIDEN) MOTHER’S NAME (FIRST) (MIDDLE) (MAIDEN)

    Please enclose a Self Addressed Stamped Envelope with your Request


    YOUR SIGNATURE DAYTIME PHONE

    ( )
    ADDRESS (STREET OR P.O. BOX) (CITY) (STATE) (ZIP)

    PURPOSE FOR WHICH CERTIFIED COPY IS TO BE USED

    YOUR RELATIONSHIP TO PERSON NAMED ON CERTIFICATE (SELF, MOTHER, SPOUSE, ETC.) (IF LEGAL GUARDIAN, MUST PROVIDE GUARDIANSHIP PAPERS)

    IF LEGAL REPRESENTATIVE – INDICATE LEGAL RELATIONSHIP

    WARNING: False application for a certified copy of a valid record is a crime.

    MO 580-0641 (07-04) VS-151

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