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Get Louisiana Electronic Event Registration System User Id Request ... - New Dhh Louisiana

Print Form Louisiana Electronic Event Registration System ADMINISTRATIVE For Vital Records Use Only USER ID REQUEST FORM DEATH MODULE Date Received / / Date Created / / User ID All Fields are required to complete Registration SECTION 1 - USER INFORMATION First Name Last Name Middle Job Title Phone Extension User Is Email Check approver if this funeral home user is authorized to sign and approve records PHYSICIAN CORONER FUNERAL DIRECTOR VR CENTRA.

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