Stillborn paper result: Fill out & sign online

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Click ‘Get Form’ to open the stillborn paper result in the editor.
Begin with Section 1, CUSTOMER INFORMATION. Fill in your full name, mailing address, city, state, zip code, and contact phone number. Indicate your relationship to the child by selecting either 'I am the MOTHER' or 'I am the FATHER'. Ensure you sign and date the application to confirm that all information is accurate.
Move to Section 2, CUSTOMER IDENTIFICATION. Choose Box A by uploading a photocopy of your government-issued ID that includes your signature. If you opt not to submit an ID, complete Box B by having your application notarized.
In Section 3, NAME OF STILLBORN CHILD, provide a name for your stillborn child if desired. If left blank, the certificate will default to Baby Boy or Baby Girl.
Finally, fill out Section 4 with details needed to locate your stillborn child's record including their name on record, date of birth, hospital or city of delivery, and both parents' names.

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