Request to Add Pre-2001 Birth Record to MR&C · Note: You are not required to send a copy of the...
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Request to Add Pre-2001 Birth Record to MR&C Use this form to request the addition of a pre-2001 birth record to MR&C. County vital records office personnel must complete this form. Email completed form to [email protected] for processing. Birth Record Information Subject Subject's first name Subject's middle name Subject's last name Name suffix Subject's date of birth (MM/DD/YYYY) Subject's sex Subject's city of birth Subject's county of birth Parents Mother’s first name Mother’s middle name Maiden Name (Name before 1 st marriage) Father’s first name Father’s middle name Father’s last name Name suffix Subject Information Is the subject of the birth record living? Yes No Paper Birth Record Information Note: You are not required to send a copy of the original record with your request. However, the Office of Vital Records will request the county record if we cannot locate a record filed with the state, or if the state record is illegible. a copy of our county paper birth record is included with this request the birth occurred in this county but we are unable to provide a copy the birth occurred in another county County Vital Records Office Requester Information Name of local issuance office requester Name of county Request date (MM/DD/YYYY) The Office of Vital Records will notify you after adding the record, or if we cannot process your request. How shall we contact you? Complete one of the fields below. Email Phone number (xxx-xxx-xxxx) OFFICE OF VITAL RECORDS USE ONLY Processer’s name Date Check one: Birth record entered Birth record could not be found Email completed form to [email protected] for processing. If you have questions about this form, contact the Office of Vital Records at 651-201-5970. Page 1 of 1 OFFICE OF VITAL RECORDS 9/2019
Transcript of Request to Add Pre-2001 Birth Record to MR&C · Note: You are not required to send a copy of the...
Request to Add
Pre-2001 Birth Record to MR&C
Use this form to request the addition of a pre-2001 birth record to MR&C.
County vital records office personnel must complete this form. Email completed form to [email protected] for processing. Birth Record Information
Subj
ect Subject's first name Subject's middle name Subject's last name Name suffix
Subject's date of birth (MM/DD/YYYY) Subject's sex Subject's city of birth Subject's county of birth
Pare
nts Mother’s first name Mother’s middle name Maiden Name (Name before 1st marriage)
Father’s first name Father’s middle name Father’s last name Name suffix
Subject Information Is the subject of the birth record living?
Yes No Paper Birth Record Information Note: You are not required to send a copy of the original record with your request. However, the Office of Vital Records will request the county record if we cannot locate a record filed with the state, or if the state record is illegible.
a copy of our county paper birth record is included with this request
the birth occurred in this county but we are unable to provide a copy
the birth occurred in another county
County Vital Records Office Requester Information Name of local issuance office requester Name of county Request date (MM/DD/YYYY)
The Office of Vital Records will notify you after adding the record, or if we cannot process your request. How shall we contact you? Complete one of the fields below. Email Phone number (xxx-xxx-xxxx)
OFFICE OF VITAL RECORDS USE ONLY Processer’s name Date
Check one:
Birth record entered
Birth record could not be found
Email completed form to [email protected] for processing.
If you have questions about this form, contact the Office of Vital Records at 651-201-5970.
Page 1 of 1 OFFICE OF VITAL RECORDS 9/2019
