APPLICATION FOR A CERTIFIED COPY MICHIGAN CERTIFICATE OF STILLBIRTH Michigan Department of Health and Human Services The Michigan Vital Records Office issues certificates of stillbirths that occurred in Michigan with information filed with the state after June 1 2003. 2894 b and 445. 65. Applicant s Signature Date Current valid Government-issued photo ID required see back for Acceptable Documents PART 3 - PURPOSE FOR REQUESTING THE RECORD PART 4 - ELIGIBILITY - Are you eligible to request this Certificate of Stillbirth Michigan law limits who can receive a certified copy of a Michigan Certificate of Stillbirth. Make checks and money orders payable to State of Michigan. PROCESSING TIMES FOR STILLBIRTH The Certificate of Stillbirth will be available within ten 10 days after the required identifying report is received by the state from the hospital or attending physician. MAIL APPLICATION TO REGULAR MAIL TO Vital Records Requests PO Box 30721 RUSH MAIL TO 517-335-8666 The Michigan Departm....
Open form follow the instructions
Easily sign the form with your finger
Send filled & signed form or save
How to fill out the MI DCH-0569-SB online
This guide provides step-by-step instructions for completing the MI DCH-0569-SB form, which is the application for a certified copy of a Michigan certificate of stillbirth. By following these instructions, you can efficiently submit your application online while ensuring that all necessary information is accurately provided.
Follow the steps to complete the MI DCH-0569-SB online.
- Click the 'Get Form' button to obtain the form and open it in a suitable online editor.
- Begin with Part 1: Applicant’s Information. Fill in your name, mailing address, city, state, zip code, and daytime phone number including area code. If applicable, provide an additional phone number.
- In Part 2: Certification of Information Provided, read the certification statement carefully. By signing, you acknowledge responsibility for payment and confirm the information provided is truthful. Enter your signature and the date.
- Proceed to Part 3: Purpose for Requesting the Record. Indicate the purpose briefly as it pertains to your request.
- In Part 4: Eligibility, mark the appropriate box to confirm your eligibility to request the certificate of stillbirth.
- In Part 5: Information Needed to Locate the Certificate, provide the required details, including the child's full name, date of delivery, place of delivery (hospital and county), and the names and dates of birth of the parents.
- Complete Part 6: Fees. Calculate the total fees based on the services requested, including base fees and additional copy costs. Make sure to total the amount and prepare the payment details accordingly.
- Once all sections are completed, review the form carefully for any errors. After confirming that all information is accurate, proceed to save your changes.
- You can choose to download, print, or share the completed form as needed.
Start filling out your MI DCH-0569-SB form online today to obtain your certified copy.
Experience a faster way to fill out and sign forms on the web. Access the most extensive library of templates available.
Related content
Michigan Department of Health and Human Services. The Michigan Vital Records Office issues...
Use professional pre-built templates to fill in and sign documents online faster. Get access to thousands of forms.
If you believe that this page should be taken down, please follow our DMCA take down process here.