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Get Certificate Of Decree Of Adoption Missouri

Affidavits containing erasures write-overs and/or white-out faxed or reproduced copies of completed form will not be accepted. 2. An item which has been amended once by an affidavit cannot be amended again by an affidavit it will require a Court Order. O. BOX CITY STATE ZIP NOTARY PUBLIC EMBOSSER SEAL COUNTY STATE SUBSCRIBED AND SWORN BEFORE ME THIS DAY OF NOTARY PUBLIC SIGNATURE USE RUBBER STAMP IN CLEAR AREA BELOW MY COMMISSION EXPIRES MO 580-0645 4-13 VS-460. MISSOURI DEPARTMENT OF HEALTH AND SENIOR SERVICES BUREAU OF VITAL RECORDS AFFIDAVIT FOR CORRECTION OF A BIRTH OR DEATH RECORD Save Print Reset STATE FILE NUMBER Indicate below the type of certificate to be amended or corrected. PRINT or TYPE the information identifying the certificate and the item to be changed. This form must be signed in the presence of a Notary Public or the request cannot be processed and will be returned. Please note 1. Affidavits containing erasures write-overs and/or white-out faxed or reproduced copies of completed form will not be accepted. 2. An item which has been amended once by an affidavit cannot be amended again by an affidavit it will require a Court Order. Missouri Department of Health and Senior Services Bureau of Vital Records P. O. Box 570 Jefferson City MO 65102-0570 Mail the completed form to Before me appears who upon his/her oath states that the original record of birth/death for PRESENT LEGAL NAME CIRCLE ONE born/died in the State of Missouri. Missouri Department of Health and Senior Services Bureau of Vital Records P. O. Box 570 Jefferson City MO 65102-0570 Mail the completed form to Before me appears who upon his/her oath states that the original record of birth/death for PRESENT LEGAL NAME CIRCLE ONE born/died in the State of Missouri. NAME AS SHOWN ON RECORD ITEM NO. /ITEM NAME MONTH/DAY/YEAR SHOULD BE CORRECTED AS FOLLOWS SHOULD READ INSTEAD OF FOR STATE USE ONLY THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE INFORMATION AND BELIEF. AFFIANT SIGNATURE MUST BE SIGNED IN PRESENCE OF NOTARY RELATIONSHIP PRESENT ADDRESS STREET AND/OR P.

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