Mississippi State Department of Health
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Please print and return the following application form:

Payment information is below. Send completed application and payment to:

Mississippi Vital Records
P.O. Box 1700
Jackson, MS 39215-1700

Instructions

Please Remember

Photo ID Requirement

If you are applying for yourself, or you are applying for someone else as their spouse, parent, grandparent, sibling, child, grandchild, guardian, or legal representative, then you must provide a completed application and a copy of your valid photo identification. Acceptable forms of identification are the following:

Guardian or legal representative must submit proof of guardianship/legal representation with this application. Legal representatives must provide attorney bar number, name of person represented, and their relationship to the registrant. If you are an agent of a local, state or federal agency requesting a record, indicate in the space provided for "relationship" the name of the agency.

Failure to Receive

If your records fail to arrive, notify the Vital Records office. Complaints of failure to receive certified records will be honored within 6 months of the original request. If the copy was to be returned to you by U. S. Postal Service, please allow 3 weeks after mailing the request before inquiring. Inquiry about copies ordered with payment for special courier delivery should be made within 7 days of the request. Mail returned because of insufficient address or address changes will be re-mailed if this office is notified of the correct address within 6 months of request.

Contact

For more information: e-mail VRInfo@HealthyMS.com or contact our Vital Records office at (601) 206-8200.



Links referenced
VRInfo@HealthyMS.com    mailto:VRInfo@HealthyMS.com

Find this page at http://msdh.ms.gov/msdhsite/index.cfm/index.cfm

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