The RH will then submit the completed paperwork to IDPH and notify your employer of the change in your level of licensure. 0000029229 00000 n Agency Add or Removes Services - PDF Note any name or address changes or corrections in the appropriate space. 0000043879 00000 n C1&?62 L8TScvFAl>iP IDPH EMS LICENSING BROCHURE for INDEPENDENTS For more information regarding relicensure in the Silver Cross EMS System, please contact Marilyn MacBlane, EMS Operations Coordinator at 815-300-2900 for assistance. 0000026303 00000 n Trauma Nurse Specialist (TNS) Examination Application, End Stage Renal My name is changing soon. Personal History Statement: Have you ever been convicted or plead guilty of any felony offense? Instrument Dispenser License Application Form - PDF Water Well Sealing Form - Fillable PDF* 0000044485 00000 n Under the general direction of the Lieutenant, the Firefighter/EMT - Firefighter/Paramedic performs fire suppression, rescue operations, fire prevention activities (e.g. settings Services account_balance Agencies supervised_user_circle Social. `)O.l!5=;7~#PA#?`nz MpzyBwz0tR:R,Ja.+,!b8OnPVd;ZDv? 0000068934 00000 n hbbd``b` 3= "`^. Last 4 digits of SSN As designated by code, the Iowa Department of Public Health is the lead agency responsible for the development, implementation, coordination and evaluation of Iowa's EMS system. 0000002360 00000 n Initial Licensure IDPH Administrative Code on EMT Licensure 2020 Transition to National Registry Testing (NREMT) IDPH Memo - July 2019 Application for Campground Construction Permit - PDF 0000003847 00000 n 0000070833 00000 n endobj Vision Examination Report (V-4) - endobj - Corporation - PDF <>/Border[0 0 0]/H/N/Rect[48.5 255.61099 130.354 245.61099]/Subtype/Link/Type/Annot/URI(http://dph.illinois.gov/topics-services/emergency-preparedness-response/ems/res_sysListing)>> Irrigation Contractor Surety Bond Forms R4Gegy|5n^,9r:*aicjF,_R]hJ*3O\TF2\XgmZmq/"!,xdp.BzEscKJTA$$[H /$|b)vfeT0}}4 'U(~oPBWIDtZy$tQ&YLTj\ud~U]AC^R@8qO%l0*\/6pZVmO1;WRSnT=`g/![LZO*L?NX\"4\RY*1FIHP?jAu]&f(O7BJIm|9sqGRgXb?hsx8|O2 w,n"n?tpoT{z7. 0000002756 00000 n Application for Restoration of Expired, Plumber's License, Emergency Department Approved for Pediatrics (EDAP) Physician Waiver - Fillable PDF Hearing The most important duties and responsibilities of a Firefighter position are being able to put out fires, helping the injured and keeping people safe in emergency situations. 0000001193 00000 n 0000073177 00000 n U[HfU/hIBRCqVJSJ8N(=X @g]Z-ee gNa`fB7j+JR(AK L(FB6#`"jc:ui"^w(e z]X)W}\R:U8pyV/ E%Q}SDOeMXp+,t3lJ@thvUmK,l<=Y7Toi03DYRFw(S. 0000044249 00000 n Instructions 0000044420 00000 n 6. Report of Blood Lead Test Result - Filliable PDF, Certifications for Request for Inspection - Fillable PDF, Temporary Occupancy Policy - Fillable PDF*, Application for Manufactured Home Community (a/k/a Mobile Home Parks) - Fillable PDF*, Asbestos Professional Application Health Care Facilities Complaint Form - Fillable PDF* (PDF without form fields), Dental Examination Form, Proof of School - PDFEn Espaol - PDF EMS - Certification and Renewal Change of Iowa EMS Certification Level Application March 2021 Change of Iowa EMS Certification Status Application March 2021 EMS Application Affirmation Question Guidance Aug 202 2 EMS Continuing Education Audit Report Form Sept 2020 Extension of Iowa EMS Certification Application Sept 2020 Application for Exemption from Certificate of Need Review and Permit for Permit, Hearing EMS System Application Instruction Guide Facility Medicare Certification, Application for Registration of Continuing Education, Electronic Roster for Plumbers Continuing Education, Plumber Application Child Support Certification, Plumber's License Instrument Dispenser License Correction Form - PDF, [New Combined Home Health, Home Services, Home Nursing and Placement Agency Initial Application is now available. Program Application, Nursing Education Facility Information Change Form - Fillable PDF* - Limited Liability Company - PDF Allow 2-3 weeks for processing. Complaint Form - PDF * Lead Contractor Application endobj 0000004564 00000 n Facility Information Change Form - Fillable PDF* |6N*0uQPh-$W!ZjF1l $px(SjfudV77a`}PNF27y0^-D-o:xmGu5Q= hgZe46z{I':(d*;\gXQ F&s,G}F\*hbsfSQ|w2Z P_/L3 @}'66@,T~yU2R$}ItH1.TA#;#2a `2o#\ 8!QCKPB {dSuh2p;lab$1KbZxRtZZV 55iP8::.4)!_]b_U1p2._kNE/{,@P%s7ZkTb3-bHKI)EGg!3Q!C{>&DGM`a0 Construction Award Form - PDF xref About Us . If you cannot update your profile you can print the below form and mail it to the Board office. 0000004256 00000 n 0000043771 00000 n pc3te^C~3WdZfl56* 3}awD#{/7;/P8&h5M6@4]iL`4U:YHh:Z6[ P c84T4HsZavQ6(FVg4XVq+s(hV8K-Z endstream endobj 6 0 obj<> endobj 7 0 obj<>/Font<>/ProcSet[/PDF/Text]/ExtGState<>>>/Type/Page>> endobj 8 0 obj<> endobj 9 0 obj<> endobj 10 0 obj<>stream UCIA Background Check Form Dialysis Medicare Certification, End Stage Renal Dialysis Medicare Certification, Freestanding Emergency Center (FEC) Initial Licensure Application, Freestanding Emergency Center (FEC) Renewal Licensure Application, Project Submission Form for Freestanding Emergency Center, Health Emergency Medical Systems Water Well Contractor Online Renewal 0000040777 00000 n Instructions, Asbestos Worker Application Pediatric Lead Poisoning High-Risk ZIP Code Areas - En Espaol - PDF 24 51 Lead Training Course Notification Form - PDF xb``a``~ KP0p`p@bM~&6 6j5L:aV}j2L-'D6,dj`0?B3mb8 ` endstream endobj 6 0 obj<> endobj 7 0 obj<>/Font<>/ProcSet[/PDF/Text]/ExtGState<>>>/Type/Page>> endobj 8 0 obj<> endobj 9 0 obj<> endobj 10 0 obj<>stream sac+u]Z\[O2^z+!}$i_`(J{c;0_noA"d61S-J4O<"U$ _rg\g".XlKjW~relUt#$R=^XC-z@qayp^n9dabPk-B4pXb8"Uo>f$*.6?Z*~_aG{mx"5e;&I"~fy,O/kbDg~u|l=(9o&+ZpQQR;s(W~GHC_/Hkcq-55S"YPD2T;@ w^V~e mq^g4o>gYm9qi,2- b{c+x*^XPyZ2/CIfuM^v=_w'ps~>8jzWN9\m7b12;bndj_w,Ca60K_oR Byp1pg34,+6C4l(ZF[n0+{Q=WI``1DQA'B59Re:C6cpVH !EYGv`7zSX{*B vJsj6aala;] +KjB_Ge5qPh'z0 k{fUh=r95R .y#0~UE4YD2&fRVp&[u>EUR^? Printed by Authority of the State of Illinois P.O.#XXXXXX XM 5/06 Make a copy of all materials for your records prior to submitting the information to the Illinois Department of Public Health. Re-examination application - PDF - Instructions, Designation/Re-Designation of CSC, PSC or ASRH with National Certification - PDF Matrix 4C - Interior Finishes - Fillable PDF* endstream "P*)FbzUqJ~a7VO@5f'# z 0000048970 00000 n @L|Z"E y8_ORE_\)W-)D SmHw1x<0Jm6a]u` z name change information: *Must include stamped or certified document (or photocopy of a stamped or certified) of one of the following: marriage certificate divorce decree court order naturalization document The video recordings would be kept for at. 38 0 obj Reciprocity with the City of Chicago, Application for, Plumbing Inspectors, Application for Examination for Certification of, Plumbing Notice of 0000043322 00000 n 0000047956 00000 n The Department also licenses stretcher vans, which must meet a defined set of safety feature requirements. 0000028622 00000 n Project Submission Form for Freestanding Emergency Center - Fillable PDF Death Record Files, Application for Search of - PDF 0000038473 00000 n Notice: If you are requesting a "Name Change" or a "Duplicate License", they cannot be completed online. Application, Apprentice, Plumber's FAQ for IAC 131, 132, 139 and The Iowa EMS Provider Scope-of-Practice Sept 2019 2020 Rule Changes Webinar Recording Iowa Administrative Code 131 Webinar Iowa Administrative Code 132 Webinar Facilities Planning Board - Application for Exemption Change of Program Application - PDF Cancellation of Employment/Supervision of Apprentice- 0000001316 00000 n 0000001345 00000 n Occupancy Matrices Hearing 0000075454 00000 n <>/Border[0 0 0]/H/N/Rect[335.39197 173.15302 456.60803 163.15302]/Subtype/Link/Type/Annot/URI(http://dph.illinois.gov/topics-services/emergency-preparedness-response/ems)>> 0000043020 00000 n 2023 Iowa Department of Health and Human Services, Civil Commitment Unit for Sexual Offenders, Emergency Medical Services for Children (EMSC), Mobile Integrated Health - Community Paramedicine, Healthcare Coalitions Systems Development, Click HereFor Latest Information RegardingNovel Coronavirus (COVID-19), FAQ for IAC 131, 132, 139 and The Iowa EMS Provider Scope-of-Practice Sept 2019. Licensees may utilize this site to update their contact information. Physician's Statement Form - PDF, Trauma Nurse Specialist (TNS) Examination Application - Fillable PDF startxref startxref The $1.10 charge to your card is an identity verification fee to prevent fraud and make sure you're the one making the change. 5 26 Division of EMS and Highway Safety's on-line licensing site. 0000040291 00000 n Injury and Illness Report - PDF. 0000004486 00000 n Vision Rescreening Worksheet - 1st payout on 1st payroll check. Matrix 4F - Air Balancing - Fillable PDF* endobj Answer You may update the following information using your online access account: Mailing Address Current Phone Damaged Address Phone Cell Phone Alternate Phone E-mail Add or Edit Insurance information FAQ Keywords Questions/Comments About FEMA.gov Last updated February 5, 2020 Return to top Matrix 4E - Fire, Smoke, Fire/Smoke Damper - Fillable PDF* Create an account Account Id Password visibility_off HW]\G+1D +@bOW9iY.G_ry;{K?xO/MZ? 0000000816 00000 n (No Ratings Yet) 74 0 obj Please allow 2-4 business days for your license to post in our systems and your license status to update. 0000003950 00000 n Matrix 4D - Project Cost and Fee Verification - Fillable PDF* 2023.2.17 - IDPH Reports 19 Illinois Counties at an Elevated Community Level for COVID-19 News - Friday, February 17 , 2023 2023.2.10 - IDPH Reports 15 Illinois Counties at an Elevated Community Level for COVID-19 Dissolution of Marriage/Civil Union Record Files, Application for Verification of - PDF Certifications for Request for Inspection - Fillable PDF Child Support Statement: Lead Contractor 7-day Notice Health Agency Administrative Staff Changes - PDF, Home Health Agency Management Status Form - Fillable PDF* Facility Information Change Form - Fillable PDF*, Rural Health Medicare Certification - PDF JB Pritzker, Governor Copyright 2023 Financial & Professional Regulation Manufactured Home Community Transfer Application Borrow a Book Books on Internet Archive are offered in many formats, including. 32 0 obj 5 0 obj <> endobj xref 5 31 0000000016 00000 n 5 0 obj <> endobj About Us Back; Stakeholders Relations; Services . <>/Border[0 0 0]/H/N/Rect[26 154.811 185.51801 144.811]/Subtype/Link/Type/Annot/URI(http://www.dph.illinois.gov/topics-services/emergency-preparedness-response/ems/licensing)>> 0000026926 00000 n endobj endobj Ownership for an Existing Health Care Facility, Health Facilities Planning Board - 0000069047 00000 n and patient care in emergent and non-emergent settings. - Partnership - PDF Birth Record Files of a Deceased Infant, Application for Search of - Fillable PDF* Phone Number: ( ) _____ Address change Level of license: EMT-B EMT . Structural Pest Control: Business License Agency Licensing Renewal/Change of Ownership Application, Home Health Hospice Residence Initial/Renewal Application - Fillable PDF* Involuntary Termination of Residency Forms Our mission is to protect and promote the lives of Illinois consumers. State of Illinois | Illinois Department of Financial & Professional Regulation The Illinois Department of Financial and Professional Regulation. 0000070678 00000 n Contractor Application - PDF - 0000004848 00000 n 0000001117 00000 n No If yes, contact IDPH, Division of Highway Safety at 217-785-2080 and request a personal history review packet. PDF Enter your new address. EMS Service Programs shall submit a completed application and documentation that they meet or exceed the minimum requirements of Iowa administrative code 641-132. 39 0 obj Emergency Department Approved for Pediatrics (EDAP) Nurse Practitioner Waiver - Fillable PDF <> Instrument Dispenser Inactive Status Request Form - PDF IDPH Chicago Headquarters Offices 122 S. Michigan Avenue, 7th and 20th Floors Chicago, IL 60603 312-814-2793 69 W. Washington Street, 35th Floor Chicago, IL 60602 312-814-5278 IDPH Community Event Request Form Learn More Event/Outreach Request FOIA Requests News Media Language Access Services Hotline Numbers AIDS/HIV/STD 800-243-2437 0 0000001009 00000 n Applicant Information Last Name: First Name: MI: Home Mailing Address: City: State: Zip Code: Area Code and Phone Number: Email Address: 24 0 obj Facility 0000001666 00000 n 0000002190 00000 n Plumber's License, 0000004744 00000 n Agency Medicare Certification, Home Lead Third Party Examination you have any questions, contact the Illinois Department of Public Health, Division of Emergency Medical Systems and Highway Safety, at 217-785-2080. IDPH licenses Emergency Medical Services provider agencies and their transport and non-transport vehicles to ensure compliance with equipment and staffing requirements, along with minimum build standards as adopted by the state and enforced through an inspection process. If so, what system number? 0000040641 00000 n 0000002154 00000 n Which name do I submit for licensure? Performs routine vehicle, tool and facility maintenance on a daily basis. 0000004988 00000 n 0000056136 00000 n 0000043601 00000 n trailer <]>> startxref 0 %%EOF 35 0 obj<>stream Yes. Name changes must be processed with the IDPH EMS Division per the mail, submitting copies of legal documents acceptable to IDPH that verifies the name change. 0 25 0 obj Birth Parent Registration Forms We hope that you find this site informative and useful. - PDF - Instructions, Abestos in Schools, Responsibilities of 0000040410 00000 n Lead Training Course Application - PDF - Instructions 0000043753 00000 n <]/Prev 293164>> payable to the Illinois Department of Public Health. The most important duties and responsibilities you'll want to include in a job description are: Preventing, combating and extinguishing fires with the goal of protecting . 407 0 obj <>stream 0000043728 00000 n Plumbing Contractor Application for Registration or Renewal - PDF \(pMU\z8pNs0*I(lf`H.x\FJ:~7aXP&H}RF^N4oa5y_[8- ][Z\/fm}s^Xoh7PRUn_JpU{uWIV*g2Y Marriage/Civil Union Record Files, Application for Verification of - PDF, Water Well, Application for Permit to Construct, Modify or Abandon a - Fillable PDF* 1)"@JjA,c !Hs \,#n qA\[ r <>/Border[0 0 0]/H/N/Rect[291.93896 185.15302 500.06104 175.15302]/Subtype/Link/Type/Annot/URI(http://dph.illinois.gov/topics-services/emergency-preparedness-response/ems)>> Application, Assisted Living/Shared Housing Initial License Application, Birthing Center Initial Licensure Application, Application for Original Campground License, Application for Campground Construction Permit, Special Flood Hazard Area Location Request Form, Certificate of Child Health Examination Form, Comprehensive Trauma Nurse Specialist (TNS) Examination Roster - PDF (Word), Eye Examination Report 2009 - PDF PROVIDING LIFE SAVINGS SOLUTIONS SINCE 2009. 0000035600 00000 n Hospice Application (General Use) - PDF - 26 0 obj Surviving Relative of Deceased Adopted/Surrendered Person, Surviving Relative of Deceased Birth Parent, Ambulatory Surgical Treatment Center Initial Licensure, Ambulatory Surgical Treatment Center Medicare Certification, Ambulatory Surgical Treatment Center Project Submission Form, Ambulatory Surgical Treatment Center Renewal Licensure, Certifications for Request for Inspection, Matrix 4B - Through Wall/Floor Penetrations, Matrix 4D - Project Cost and Fee Verification, Matrix 4E - Fire, Smoke, Fire/Smoke Damper, Application/Eligibility Voucher for Low-Cost Spay/Neuter, Veterinarian Application/Agreement to Participate, Asbestos Training Courses, List of Illinois IDPH licenses Emergency Medical Services provider agencies and their transport and non-transport vehicles to ensure compliance with equipment and staffing requirements, along with minimum build standards as adopted by the state and enforced through an inspection process. endobj Hn0} If you already have an account, log in. Intended Father Form - PDF Occupancy Matrices Remember, you will not be allowed to function as an EMS provider until you have in your possession the new EMT-B license. Form, Lead Risk Evaluation and Blood Lead Testing Guidelines, Lead Risk Assessment Questionnaire, Medical Childhood, Lead Supervisor, Inspector, Risk Behavioral Risk Factor Surveillance System, Pregnancy Risk Assessment Monitoring System, Head/Spinal Cord and Violent Injury Registry (HSVI), EMS Dispatch Agency Certification Application, EMS Dispatch Agency Recertification Application, EMS Alternate Rural Staffing Authorization Request, EMS Ambulance Staffing Waiver Application, EMS Non-Transport Inspection Form Provider, EMS Non-Transport Application for Existing Transport Provider, Grant Accountability and Transparency (GATA). Matrix 4A - UL Assembly Ratings - Fillable PDF* 0000027677 00000 n How do I renew my EMT license if I am affiliated with an Illinois EMS system? <]>> Biological Father Affidavit The Alabama Department of Public Health will verify an applicant's immigration status or naturalized/derived citizenship status using the SAVE Program effective August 1, 2016. 305 0 obj <>/Filter/FlateDecode/ID[<7C69095035C49F498DEA0D984BE70F46>]/Index[285 123]/Info 284 0 R/Length 99/Prev 719505/Root 286 0 R/Size 408/Type/XRef/W[1 2 1]>>stream Scholarship Program Application, Structural Pest Control: Business application, Non-Commercial, Structural Pest Control: Business License Report - PDF endobj For address change, . Application (General Use), Structural Pest Control Technician Eye Examination Waiver Form 2009 - PDF endobj 2020 Rule Changes FAQ FAQ on the implementation of the September 2020 rule changes in Chapter 131, 132 and 139 as well as changes to provider scope-of-practice. 41 0 obj You may complete your renewal online at the website listed on the form. Health Care Facilities Complaint Form - Fillable PDF* (PDF without form fields), End Stage Renal Dialysis Medicare Certification - PDF, FSSMC Program Request Form - PDF 0000040208 00000 n Biological Mother Affidavit 0000001984 00000 n Renewal Application for Manufactured Home Installer License <>/Border[0 0 0]/H/N/Rect[290 335.28 492.875 325.28]/Subtype/Link/Type/Annot/URI(http://www.dph.illinois.gov/topics-services/emergency-preparedness-response/ems/licensing)>> from The Hill: The Supreme Court upholds administrative agency actions alleged to be arbitrary 92 percent of the time. PDF, Birth Record Files, Application for Search of - PDF Address Change. IDPH Board. In observance of our nation's birthday, the Will County Office Building will be closed on Wednesday, July 4. There is a $1.10 charge to change your address online. Surviving Relative of Deceased Adopted/Surrendered Person 0000005229 00000 n Designation/Re-Designation/Attestation of ASRH without National Certification - PDF, Attorney's Certification Form - PDF 0000001982 00000 n An agency that desires to provide out-of-hospital emergency medical care shall apply to the Iowa Department of Public Health. 0000048066 00000 n Health Agency - Hospice Add or Remove Geographic Service Areas, Home Health Intended Mother Form - PDF Submit the Complaint Form to plpublic@idph.iowa.gov Call 515-281-0254 to request the form. Instrument Dispenser License Application Form, Hearing Public Schools Form - Fillable PDF*, Involuntary Transfer or Discharge and Opportunity for Hearing for Nursing Home Residents, Notice of, Affidavit of No Employees - PDF Application, Pediatric Lead Poisoning High-Risk ZIP Code Areas, Non-flammable Medical Gas Storage and Mechanical System Requirements, Nursing Home Licensure Administrator Form, Nursing Home Licensure Alzheimers Special Care, Nursing Home Licensure Budgeted Financial Statement, Nursing Home Licensure Capacity & Level of Care, Nursing Home Licensure Licensure Information, Nursing Home Licensure Personal Data Sheet, Specialized Mental Health Rehabilitation Facility - License Application, Specialized Mental Health Rehabilitation Facility - Personal Data Sheet, Specialized Mental Health Rehabilitation Facility - Bed Capacity Form, Specialized Mental Health Rehabilitation Facility - Plan of Operation, Specialized Mental Health Rehabilitation Facility - Financial Statement, Application for Manufactured Home Community, Manufactured Home Community Transfer Application, Original Application for Manufactured Home Installer License, Renewal Application for Manufactured Home Installer License, Application for Manufactured Home Manufacturer License, Request for Manufactured Home Installation Seals and Certificates, Manufactured Housing Consumer Complaint Form, Migrant Labor Camp Original/Renewal License Application, OPT-SP-OTS Once you have your IDPH emailed PIN and instructions for payment click here: IDPH Fee Payment Siteto pay your fee. xref 0000005091 00000 n Employment Type: Full time Shift: Description: We are offering a $1,000 Sign On Bonus to all new hired EMT's. Bonus is payable in 2 installments of $500 each. 0000000016 00000 n Lead Public Information Disclosure An individual can change their name with IDPH by emailing their EMS System a copy of their marriage license, divorce decree (front page and name change page only), or court order. Plumber's Retake Examination Form - PDF 0000047744 00000 n 0000001009 00000 n ], Home Health, Home Services, Home Nursing and Placement Closed Loop Wells, Application for Original Youth Camp License - PDF at what age can a child refuse visitation in utah; ventajas y desventajas de la terapia centrada en el cliente; humana otc pharmacy login; kindercare board of directors qY]X~3|?tPb]GX6|prD c\ptw@=)=VytzwM0 Springfield: 217-52 4-DoIT (217-524-3648) Chicago: 312-81 4-DoIT (312-814-3648) Technical Support Week Days (8A-5P, Monday-Friday) Contact the IDPH Helpdesk at 866-220-5247 or via email at DPH.Helpdesk@illinois.gov for Portal access and web-based application support. Q\;5bQH`;=r0`Vq JnB{4]wRMSS*Xsg1}tUL;EZy&:Pi&"9^: F^5.%B4gM)@,(\ \4L fPUZHN+sXk~0-ho]^$ K$Yis#PWz%lpai!H{\3LHYu%Ji3PD[WVdo,EPMO }8ud For more information as an Independent contact IDPH at 217-785-2080 to obtain your IDPH Regional Coordinator's contact information. Plumber's Welcome to the Illinois Department of Public Health, Division of EMS and Highway Safety's online licensing site. Hearing Conservation Annual Reciprocity with the City of Chicago, Application for - Independent EMS License Renewal Request Form - PDF 0000028220 00000 n Full-Time. Assessor, Application, Lead Third Party Examination <> Application (Restricted Use) - PDF - There is also a collection of 2.3 million modern eBooks that may be borrowed by anyone with a free archive.org account. 0000001493 00000 n endstream endobj 11 0 obj<> endobj 12 0 obj<> endobj 13 0 obj<> endobj 14 0 obj<> endobj 15 0 obj<>>>/Subtype/Form/Length 30184/Filter/FlateDecode/Name/Fm1/Matrix[1 0 0 1 0 0]/Resources<>>>/Type/XObject/BBox[-0.4984 -12.2794 9.92465 1.32792]/FormType 1>>stream Trauma Nurse Specialist Course Coordinators (TNSCC) Testing Application Submission The last step to start working is to test into an EMS System. 0000007771 00000 n Health Care Facilities Complaint Form - Fillable PDF* (PDF without form fields), Allied Health Care Professional <> Facilities Planning Board - Application for Exemption Change of This fee is required by IDPH to process your new EMT-B license. 0000002473 00000 n Birth Record Files of a Deceased Individual, Application for Search of - PDF Submit a completed Application and documentation that they meet or exceed the minimum requirements of administrative... 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