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Request For Verification Of A Michigan Birth Record - Michigan
| Request For Verification Of A Michigan Birth Record Form. This is a Michigan form and can be used in General Statewide . |
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REQUEST FOR VERIFICATION OF A MICHIGAN BIRTH RECORD For Additional Information: (517) 335-8666 www.michigan.gov/mdch Please type or print clearly and legibly - this application will be used as a mailing insert APPLICANT (PERSON REQUESTING VERIFICATION) DATE: / / ³ Agency Name ³ Applicant=s Name ³ Mailing Address ³ City/State/Zip K APPLICANT=S SIGNATURE: = K (Sign Here) _______________________________________________ Must be signed in order to process VERIFICATION INFORMATION - A request for a verification of a Michigan birth record (since 1906) will be returned to you stamped with an indication that a record was identified which matched the supplied facts, or that no record could be identified which matched the supplied facts. State law (MCL 333.2881(2)) allows for verification of ONLY name of the subject of the birth record, date of birth, place of birth and filing date. This information must match exactly what is on the record. No additional information can be verified or supplied by the Vital Records Office. State law (MCL 333.2891(4)(f)) requires a $10.00 fee for each search of the facts for verification. FACTS TO BE VERIFIED Name on the Record (Must match exactly what is on record) METHOD OF PAYMENT - Payment must be made in U.S. funds by check or money order payable to the AState of Michigan@ @ Each Verification Search (Non-Refundable) $ $ 10.00 10.00 _____________________________________________ First Middle Last Date of Birth (Must match exact date on record) * EXPEDITED SEARCH (Non-Refundable) (In addition to the regular search fee) TOTAL ENCLOSED $ __________________________________________________ Month Day Year Place of Birth __________________________________________________ County We cannot process your request without payment. When mailing, please remember to include check or money order. IF REGULAR SEARCH: VITAL RECORDS REQUESTS P.O. Box 30721 Lansing MI 48909 IF EXPEDITED SEARCH: VITAL RECORDS RUSH PO Box 30721 Lansing MI 48909 Date of Filing (Date the record was filed - Enter ONLY if you have a copy of the record) If you wish to have the results of the verification faxed to you, please indicate the fax number here: ( ) ___________________________ VERIFICATION STAMP (for Vital Records Official Stamp) TURN-AROUND TIME - For regular or expedited mail requests, please allow additional time for mailing and our department=s receipting of your payment. REGULAR SEARCH - Processing time will be 4 weeks for mail or counter requests. EXPEDITED SEARCH - If you pay the expedited search fee (in addition to the regular search fee), a mail request will be processed in 2 weeks and a counter request will be processed in 1-3 hours . DCH-0569-VERBX Rev 3/9/06 American LegalNet, Inc. www.FormsWorkflow.com
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