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Click ‘Get Form’ to open it in the editor.
Begin by filling out the 'Required Identifying Information on Requester' section. Enter your first name, middle name, last name, and any other names you have used.
Provide your residence street address, telephone number, city, date of birth, county, state, and zip code. Ensure all information is accurate for a successful check.
Indicate your gender and ethnicity by selecting the appropriate options provided in the form.
List all places you have resided for at least the past five years in the designated area.
In the 'Send Results of Central Registry Check To' section, specify whether results should be sent to you or a designee. If choosing a designee, fill in their details accurately.
Finally, sign and date the form. Ensure that it is notarized before submission.
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Care must be taken during sample retrieval and handling to insure that the inner LDPE tubing or bag remains clean. A clean inner bag is necessary to insure thatRead more
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