In this blog post I will be discussing the Form Phs520D, which is a carbon monoxide detector. This detector is important for both homes and businesses to have in order to keep occupants safe from the dangers of carbon monoxide poisoning. I will be going over some of the features of the Form Phs520D and how it can help protect you from Carbon Monoxide poisoning. I will also discuss some of the common problems that can occur with these detectors and how to fix them. So if you are interested in learning more about the Form Phs520D, then please keep reading. Thanks!
| Question | Answer |
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| Form Name | Form Phs520D |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | BirthResultingS tillbirthApplic ation louisiana phs520f form |
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DEPARTMENT OF HEALTH AND HOSPITALS |
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OFFICE OF PUBLIC HEALTH |
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VITAL RECORDS REGISTRY |
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APPLICATION FOR BIRTH RESULTING IN STILLBIRTH CERTIFICATE |
PHS 520D |
Rev. (9/07) |
FOR MAIL SERVICE: SUBMIT COMPLETED APPLICATION, COPY OF STATE ISSUED PHOTO ID and CHECK OR MONEY ORDER TO: VITAL RECORDS REGISTRY, P.O. BOX 60630, NEW ORLEANS, LA 70160. PLEASE DO NOT SEND CASH.
IF NO RECORD IS FOUND, YOU WILL BE NOTIFIED AND FEES WILL BE RETAINED FOR THE SEARCH PER R.S. 40:40.
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NOT FOR USE TO ORDER CERTIFICATE OF LIVE BIRTH OR CERTIFICATE OF DEATH
Complimentary Birth Resulting in Stillbirth Certificate |
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1 Copy |
NO FEE |
Additional Birth Resulting in Stillbirth Certificate |
# Copies Requested: |
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at $15.00 each = |
$ |
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TOTAL FROM ABOVE: |
$ |
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Mail Orders add .50 state charge per transaction |
$ |
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TOTAL FEES DUE: |
$ |
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* See note below
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NAME OF STILLBORN (IF APPLICABLE) |
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DATE OF STILLBIRTH |
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SEX |
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HOSPITAL OF DELIVERY |
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PARISH OF STILLBIRTH |
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FATHER'S NAME (IF APPLICABLE) |
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MOTHER'S FULL MAIDEN NAME - BEFORE MARRIAGE |
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RELATIONSHIP TO PERSON NAMED ON THE CERTIFICATE: |
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(MUST SUBMIT PHOTO ID) |
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Check one: |
___Mother ___Father |
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PRINT NAME AND MAILING ADDRESS OF APPLICANT: |
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NOTE: PLEASE CHECK THE FOLLOWING: |
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Name |
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Street or |
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____Signed Application |
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Route No. |
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City and |
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____Copy of Federal or State Photo ID |
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State |
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Zip Code |
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____Correct Fees |
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Home |
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Office |
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Phone No. |
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Phone No. |
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I AM AWARE THAT ANY PERSON WHO WILLFULLY AND KNOWINGLY MAKES ANY FALSE AN APPLICATION FOR A CERTIFIED COPY OF A VITAL RECORD IS SUBJECT UPON CONVICTION TO A FINE OF NOT MORE THAN $10,000 OR IMPRISONMENTOF NOT MORE THAN FIVE YEARS, OR BOTH.
Signature of Applicant: _____________________________________________________________
*PLEASE NOTE: Birth records over 100 years old and Death records over 50 years old can be obtained by writing the Secretary of State. Address: Louisiana State Archives, P.O. Box 94125, Baton Rouge, LA