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Donor Registry Enrollment Form BMV 3346 - Ohio

Donor Registry Enrollment Form Form. This is a Ohio form and can be used in Miscellaneous Bureau Of Motor Vehicles Statewide .
 Fillable pdf Last Modified 6/11/2010
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DONOR REGISTRY ENROLLMENT FORM To register, please complete and mail this enrollment form to: Ohio Bureau of Motor Vehicles Attn: Records Request Unit P.O. Box 16520 Columbus, Ohio 43216-6520 Yes, I want to join the Donor Registry! Please take me out of the Donor Registry. ANATOMICAL GIFT OF (Print or type name of living donor) In the hope that I may help others upon my death, I hereby give the following body parts: (Specify all organs/tissues to be donated, or indicate "all") for any purpose authorized by law: transplantation, therapy, research, education, or advancement of medical or dental science. Signed by the donor and the following two witnesses in the presence of each other: SIGNATURE OF DONOR DATE SIGNED SOCIAL SECURITY NUMBER DRIVER LICENSE OR ID NUMBER X DATE OF BIRTH OF DONOR WITNESS X WITNESS X This is a legal document under the Uniform Anatomical Gift Act or similar Laws. BMV 3346 5/08 American LegalNet, Inc. www.FormsWorkflow.com
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