Report of Lost or Stolen Certificate Form 1 2016 .pdf

File information


Original filename: Report-of-Lost-or-Stolen-Certificate-Form-1-2016.pdf
Title: December 23, 2008
Author: Barnhart Communications

This PDF 1.5 document has been generated by Microsoft® Word 2010, and has been sent on pdf-archive.com on 17/11/2016 at 07:22, from IP address 99.57.x.x. The current document download page has been viewed 199 times.
File size: 286 KB (1 page).
Privacy: public file


Download original PDF file


Report-of-Lost-or-Stolen-Certificate-Form-1-2016.pdf (PDF, 286 KB)


Share on social networks



Link to this file download page



Document preview


Thomas Forslund, Director

Governor Matthew H. Mead

REPORT OF STOLEN BIRTH CERTIFICATE OR IDENTITY
(Only for birth’s occurring in Wyoming)

This form cannot be used for requesting a birth certificate
Name, address, and phone number of person completing this form:
Full Name: _________________________________________________________________
Phone: ____________________________________________________________________
Address: ___________________________________________________________________
City, State, Zip: ______________________________________________________________
Information on the birth certificate that is missing or stolen:
Full Name on Certificate: ______________________________________________________
Date of Birth: _____________ City or County of Birth in Wyoming _______________________
Mother’s Full Maiden Name: ____________________________________________________
About what date was the certificate missing or stolen: ________________________________
Please write a brief statement about what happened to the birth certificate:

Signed: ____________________________________ Date: _________________
Notice: In an effort to protect the Registrant from Identify Theft, records associated with lost or stolen birth certificates are
flagged. Information may be shared with appropriate law enforcement agencies in an effort to protect the people of Wyoming
from the threat of Identity Theft.

Return this form to:
Vital Records Services
Hathaway Building
Cheyenne, WY 82002

Wyoming Department of Health • Vital Statistics Services
E-Mail: wdh.vss@wyo.gov • WEB Page: www.health.wyo.gov
Main Number (307) 777-7264 • FAX (307) 777-2483
WDH_VSS Report of Lost or Stolen Certificate Form 1 2016


Document preview Report-of-Lost-or-Stolen-Certificate-Form-1-2016.pdf - page 1/1


Related documents


report of lost or stolen certificate form 1 2016
birth application form 1c 2016
student registration form
csa travel insurance1
2003 lexus rx300 nicb vincheck jtjhf10u930294977
000 double m trucking dqf packet

Link to this page


Permanent link

Use the permanent link to the download page to share your document on Facebook, Twitter, LinkedIn, or directly with a contact by e-Mail, Messenger, Whatsapp, Line..

Short link

Use the short link to share your document on Twitter or by text message (SMS)

HTML Code

Copy the following HTML code to share your document on a Website or Blog

QR Code

QR Code link to PDF file Report-of-Lost-or-Stolen-Certificate-Form-1-2016.pdf