A fee is required for this type of application. This form can be filed by mailing it to Texas Vital Records, Department of State Health Services, 1100 W. • Application to change an adult’s name – use if you want to change your own name and you are 16 years of age or older and you have lived in Ontario for the last 12 months before sending the application. unexpired U. application for certificate of ownership city, state, zip code street date of birth name n. We can process documents issued from all areas of Texas including: Houston, San Antonio, Dallas, Austin, Fort Worth, and El Paso. Do not request two different types of certificates on the same form. citizen child under the age of 18 who was born abroad and who acquired U. It is a copy of the original birth certificate. This information is protected by the privacy provisions of the. Complete the In Office Application for Birth and Death Record listing the individual's name, date of birth, father's name and mother's maiden name. Warning: False application for a vital record is a criminal offense and punishable by fine and/or imprisonment. In order to obtain a Certified Copy as of July 1, 2003, you must complete the sworn statement included with the birth certificate application form and sign the statement under penalty of perjury. We strive to provide our public with quality online information and capabilities to assist in daily government related activities. Dallas County Clerk; 500 Main St Ste 200; Dallas TX 75202. Birth/Death Certificate Information Short Form Abstract Birth Certificate This format satisfies most purposes, including registering a child for school or sports and obtaining a driver license in most states. Here you can see the sample document of Nadra Birth Certificate, As Now Nadra Computerized Birth Certificates are being issued in Pakistan, you can review the sample certificate of Nadra Birth Certificate, below Sample birth. Birth Certificate Online – Apply & Download : Birth Certificate is an important document that certifies the birth of child. 16, 2015, photo, a woman in Sullivan City, Texas, who said she entered the country illegally shows […]. Non-preferential certificate of origin is the form of certificate issued for the purpose of complying with non-preferential rules of origin. State Department External. The application form requires applicants to provide. (Please delete inapplicable) Payment of Fee (to be filled by applicant). Fast We have streamlined the vital records application process to allow you to request a birth certificate from any state in the U. A Birth Certificate Application or Death Certificate Application is available at each location or you can complete the online form or print an application prior to visiting the office. (Please be aware that N. if you don't know the exact date of birth. Check or money order payable to: Missouri Department of Health and Senior Services. Information for Death Certificate: Decedent’s SSN Decedent’s Birth Date Decedent’s Birth Place WARNING: THE PENALTY FOR KNOWINGLY MAKING A FALSE STATEMENT IN THIS FORM CAN BE 2‐10 YEARS IN PRISON AND A FINE OF UP TO $10,000 (HEALTH & SAFETY CODE, CHAPTER 195, SEC. A new birth certificate may be filed that incorporates the corrected sex of the person named on the birth certificate. Full Name of Child 2. There is one version of this form for each of the following events: a birth, a marriage ou a civil union, a death, a change of name or a change of sex designation. An ID is required to process your application. Fresh Sample Affidavit For No Birth Certificate. Authorized individual must also provide valid. We will begin to process your application when we receive your documents. Looking for the fastest way to order an Official Texas Birth Certificate? Whether you’re looking to apply for a passport, marriage license, or just need to register your child for school, we’ll process your order in 24 hours. Relationship to Person. birth as shown on the record filed with the Bureau of Vital Statistics or local registration official. Letter Of Request Format Sample Letter To Request Birth Certificate. name and complete address of attorney (please type or print) telephone number ( ) send new certificate to check one parents attorney county clerk other name part iii application for certified copy of the new birth certificate and fee may be attached to this form and forwarded to the bureau of vital records. A birth certificate is an official recording of a birth that occurred in the state of Georgia. Instructions and Application Form for Free Computerized Birth Certificate. This Texas-specific "Application Form for Certified Copy of Birth or Death Certificate" is a document released by the Texas Department of State Health Services. The individual, parent, guardian or a person who has custody of the individual may correct the birth certificate if the following is submitted: Less Than Ninety (90) Days After Birth. A Consular Report of Birth Abroad of a U. Application for Certificate Applicacion para Certificado Bureau of Vital Statistics INSTRUCTIONS DELAYS • Read all instructions carefully before completing application. You must complete the online authentication or send in the notarized Certificate of Identity. Birth Certificates Death Certificates. passport, Certificate of Naturalization, U. Completed application (below). PDF Form used by a foreign business entity to reserve their name until the end of the calendar year on the Secretary of State records. Date of Birth City. To obtain a certificate, provide the following information to the Texas Workforce Commission, Labor Law Section, 101 East 15th Street, Room 124T, Austin, Texas 78778-0001: 1. If your Birth Certificate is lost, damaged, or older than what the State will accept, we recommend that you order a new certified copy by visiting VitalChek. Any one of the following (copies preferred) as proof of age: a. This search of the Notice of Commencement of Paternity Proceedings is for ADOPTION use only. The short form is acceptable for most legal and identification purposes. • Birth Certificate of Grandchild or Verification of Birth Facts Form* proving relationship to Subscriber; and • Birth Certificate of Biological Parent; and • Grandchild Certification Form*; and • Most recent tax return indicating grandchild is the financial dependent of Subscriber. €dependents' application for va education benefits (under provisions of chapters 33 and 35, of title 38, u. " Fees are non-refundable. pdf 105k The forms are now ONLY available for download on the EDRS System. Enter number of Birth Certificates being purchased. Present the completed form, a valid picture I. 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Notification of Order of Parentage and Application for a New Birth Certificate (PH-3343) Rescission of Voluntary Acknowledgment of Paternity (PH-3490) Application for a Certificate of Birth Resulting in Stillbirth (PH-4107) Application and Worksheet for Nonviable Certificate (PH-4347) Death. EACH LONG/ BABY FORM. Birth Certificates How to Order a Birth Certificate: Birth must have occurred in Kern County a. Vital records (birth, death, civil union, marriage, and divorce certificates) for events that occurred in Hawaii are received and preserved by the Office of Health Status Monitoring, a unit of the Department of Health. - forearmforklreviews. TexasNameChange. Fresh Sample Affidavit For No Birth Certificate. Submit form with original signature and keep a copy for your records. Application is hereby made for the homestead exemption provided by Section 170 of the Kentucky Constitution. The application form is also available in our lobby. in addition to one Heirloom certificate. The relationship must be stated (i. Short form Birth Certificate - An abstract of the birth record. €dependents' application for va education benefits (under provisions of chapters 33 and 35, of title 38, u. [ ] My payment is ready. ORGAN DONOR DESIGNATION Pennsylvania strongly supports organ and. Certificate Information. 063(e), the [The] registrar shall make the determination not later than the seventh day after the date the application is submitted to the registrar. Easy and convenient By following our step-by-step instructions and completing the simple online application form, you can prepare your vital records application for any State in the U. How to Down load Texas Notary Affidavit Form? Click here to retrieve Texas Notary Affidavit Form to your desktop computer. Payment Form - Form for use in. • Child listed on the certificate (if 14 years old or older) along with a school ID. Public Health District, 850 N. Certificate by Mail. Additional copies are $3 dollars each. co german birth certificate template – amartyasen Top Death Certificate Template Texas , source image from amartyasen. In addition to a voter registration certificate, Texas’s current election code recognizes eight broad categories of documents as “acceptable” voter ID. Q: How much do birth certificates cost? ORDER NOW. Birth Certificate Application Form Kenya. MOTHER’S CURRENT LEGAL NAME. The certificate will reflect the child's name, date. Government Code 552. Form vs-166 or the "Application For A New Birth Certificate Based On Parentage" is a form issued by the Texas Department of State Health Services. Texas Death Certificate Sample Fresh Texas Long Birth Certificate. Ordering a Texas Birth Certificate. Make check or money order payable to the "State Board of Health. Name of Veteran Type of certificate requested Birth Death In accordance with Arkansas Law 20-18-306 (a) 2 A, I request a free copy of the certificate checked above. Texas Hazlewood Act Exemption Application indicated on the DD Form 214 3. current birth certificate. Acceptable forms include: valid passport, birth certificate, a photocopy of your U. Abstract copies may not be suitable for Passport purposes. Claim Number:. For service by fax or mail: Use the Birth Certificate Application (PDF) form to order a certificate. Non-preferential certificate of origin is the form of certificate issued for the purpose of complying with non-preferential rules of origin. Check Status For Marriage Certificate Online- Marriage Certificate is necessary for Married Couples because it is a proof that you are legally married with a person. Enter the document number that appears at the bottom of the document you wish to verify, then click on the Validate button. The same eligibility and identity requirements for any birth certificate also apply to the request for an heirloom certificate. Complete the In Office Application for Birth and Death Record listing the individual's name, date of birth, father's name and mother's maiden name. Use the form below to correct information on a certificate of title or certificate of origin that contains errors, erasures or alterations. Texas Vital Records | which will be listed on the application form, along with your payment (check or money order) Certified birth certificate from the. Birth Certificates & Parentage Forms Under Vermont law the attending physician or midwife is responsible for filing a report of birth with the State Registrar within five business days. The traditional way to apply for a Pennsylvania birth certificate begins with a visit to the Pennsylvania Department of Health website. THE STATE OF TEXAS requires the CITY OF DALLAS, BUREAU OF VITAL STATISTICS to obtain and retain a photo or electronic copy of a. Only those requesting a copy of their own birth certificate or those requesting a birth certificate copy of a member of his/her immediate family may obtain a one. BIRTH CERTIFICATES. CITIZENSHIP: BIRTH CERTIFICATE OR PASSPORT. Birth Certificate in Kenya: Perceived as a vital document, birth certificate application in Kenya can only be done by people who qualify for Kenyan citizenship by descent in Kenya. Single Status Certificate Overseas marriage authorities often require evidence a party to the marriage is free to marry. Obtain and complete an application for a certified copy of a birth certificate. BIRTH OR DEATH CERTIFICATE APPLICATION *Please see back of form for complete instructions and eligibility requirements* 1. • Application to change an adult’s name – use if you want to change your own name and you are 16 years of age or older and you have lived in Ontario for the last 12 months before sending the application. Our legal forms and spreadsheets are state-specific and free to download in PDF format. Birth Certificate Sample In Bangladesh. Birth Certificate Application – English Birth Certificate Application – Spanish Certificate ID Requirements. PWD 581 - A0900 (08/16) Texas Parks and Wildlife Department • 4200 Smith School Road, Austin, TX 78744 • www. mm dd yyyy mm dd yyyy. APPLICATION FOR COMPUTERIZED BIRTH CERTIFICATE First Name A person is entitled to only one (1) free Birth Certificate. Free Sample Example Format Templates Download word excel pdf birth certificate document number birth certificate ghana birth certificate a bond. Birth Certificates Death Certificates. This $35 fee will provide for the issuance of both one Heirloom birth certificate and one standard Certified birth certificate. 00 must be paid for each copy of birth certificate and a single $2. The Bureau of Vital Statistics maintains birth records from December 20, 1908 and death records from 1964 to present. Social Security Administration. birth date: birth place, etc. This petition is being served upon the State Registrar of Vital Records, at 1600 Skyland Dr. Marriage License Application [LINK]. at 1395 Eisenhower Drive (912-356-2138). • Complete a separate application for each record requested. To amend a death certificate, fill out Form VS-172. TIME OF BIRTH (24 hr) 3. For people born in Texas, we might be able to get the birth certificate electronically and you won't need to provide it. The fee is charged regardless of whether a record is found or not. It is issued by Government of the India on registering the name of child at the time of his/her birth. Last Name(s) 1c. Visit Help with PDF Files if you have questions or to download Adobe's free Adobe Reader program. The licensing fee is $200. 2300 Bloomdale Road, Suite 2106. The Adobe Acrobat Reader is free to download and install on your computer by clicking on the button: Download Request For Certified Copy of Birth Record (Form Fillable). ARKANSAS DEPARTMENT OF HEALTH. Fresh Sample Affidavit For No Birth Certificate. • **We issue certificates for births and deaths that occurred in Washington State only, after July 1, 1907. Name on Birth Certificate First Name Middle Name Last Name on Birth Certificate Sex Male Female Date of Birth (mm/dd/yyyy) Place of Birth City State Hospital if Known. The following pertains to information that would be found on the certificate being requested. Please restart your order. For birth records in Ohio from 1867 – December 20, 1908, please contact the probate court for the county that the birth occurred. (if business-corpcode) name eye color eye color sex lienholder owner co-owner x x x. section i (fill in every item in this section) 2. SECURE MOBILE ORDER FORM STEP 2: In what state did the birth take place? HAVE QUESTIONS? Get live help from our experts. Hello Sharon and thank you for your question. Instructions • Print clearly. By signing this, you agree that the facts you have given may be used to determine if you qualify for the Texas Women's Health Program, run by HHSC. The birth certificate must be translated if not in English. Military Discharge Request. org if assistance is needed selecting the correct form for your order. I have previously used hours under the Texas Hazlewood Act Exemption. Online order accepts Visa and MasterCard. Texas Real Estate Commission P. Application Types. ) Death Certificate Mail-in Application (pdf, 126 kb, 2 pp. MAIL APPLICATION FOR BIRTH AND DEATH RECORD OFFICE USE ONLY Birth Certificates Type Cost X # of copies= Total Certified Copy $23 Total I wish to make a voluntary contribution of $5. Vital records are available from 1907 to present from the state office for a fee of $20 dollars. Money Order or Cashier’s Check for the $515 application fee. Instructions and Application Form for Free Computerized Birth Certificate. The Birth certificate template refers to a document that is designed by experts to aid the user in coming up with a birth certificate using their personal computers. Birth certificates can be requested online, by telephone, by mail, or in-person. • Complete a separate application for each record requested. FORECLOSURE NOTICE 134. Whānautanga, Matenga, Mārenatanga. Abstracts may not be suitable for a passport* 2. Enter the document number that appears at the bottom of the document you wish to verify, then click on the Validate button. Expedited service is an additional $20 dollars. 00 for each additional copy of the same record. Can I use the birth certificate I received to obtain a passport, if I select the reason for my request is to obtain a passport? Yes, the certificates are official, raised seal - long form version certificates certified by the Texas Department of State Health Services accepted by all state and federal agencies suitable for obtaining a passport. LETTER TO CUSTODIAN OF BIRTH RECORDS. A registered voter in Texas and present a valid voter registration certificate, or are eligible to vote and submit a voter registration application to the Department. APPLICATION FOR AMENDED BIRTH CERTIFICATE BASED ON A COURT ORDERED NAME CHANGE Budget ZZ 708-153 This form may be used to file a legal name change amendment if submitted with a certified copy of a court ordered name. statements on this application or to fraudulently obtain a vital records certificate. (402) 471-0918. Though most name changes require a court order, certain instances (e. Make money orders payable to: City of McAllen - Vital Statistics. Texas Name Change Kits for Download to Legally Change Your Name Without a Lawyer. If located, the search fee includes one copy. Adding a father to a birth certificate is a two-step process. Graduation Affidavit (form provided on web). • Use this application to mail your request. The lists below are in accordance with Texas Department of State Health Services. Full-time Graduate student (minimum 9 hours). If you are unable to complete the application form online, you can use the PDF application form and apply by post or in person. 5 and 26-23-6. This is a certified copy of the original on security paper that meets state requirements, which bears our Health Department Seal and the Texas State Health Department seal within the paper. Instructions: The requester - the person submitting this application - must show an acceptable identification document(s) from the list on the back of this form and. EACH LONG/ BABY FORM. This $35 fee will provide for the issuance of both one Heirloom birth certificate and one standard Certified birth certificate. APPLICATION FOR CERTIFIED COPY OF BIRTH RECORD. The birth certificate templates provided on this site can be customized to suit your needs and preference. Documents for which Texas SOS will not issue an Apostille Birth certificate for someone residing in Texas but who was born in Oklahoma. TYPE OF CERTIFICATE BEING ORDERED PART 4. Use the form below to correct information on a certificate of title or certificate of origin that contains errors, erasures or alterations. Must include a copy of a valid form of identification. Form DL-80CD will require notarization. For Applicants Born in the Philippines. RELATIONSHIP TO REGISTRANT: A person ordering his or her own certificate should enter "SELF" in this space. There are several state statutes and regulations which govern the process to amend birth records. How to Fix Birth Certificate Errors. You must complete the online authentication or send in the notarized Certificate of Identity. APPLICATION. Please be sure to follow the instructions on the VitalChek site. TASFA (Texas Application for State Financial Aid) Check list – Dependent Students Name: _____CWID: _____ Texas Application for State Financial Aid Application Check to be sure ALL spaces are filled in Application must be signed and dated by both student and 1 parent SB1528 Statement Form. If you mail your request, your sworn statement must be notarized. Request for Putative Father Search and Affidavit of Search Results (State Form 54808) Birth. application for certificate of ownership city, state, zip code street date of birth name n. CERTIFICATION The undersigned certifies that all of the information provided in this application is true and correct as of the date below. Birth certificate of Mary Elizabeth Winblad (1895–1987) A birth certificate is a vital record that documents the birth of a child. Learn about topics such as How to Find Free Public Birth Records, How to Obtain a Copy of Your Birth Certificate in Ohio, How to Obtain a Copy of Your Birth Certificate in California, and more with our helpful step-by-step instructions with photos and videos. Fresh Sample Affidavit For No Birth Certificate. Mail this completed form with all required attachments to: State of California. unexpired U. Texas also requires that both applicants present either photo ID or a certified birth certificate in order to prove their age and identity when they file their application. com is not owned, operated, or affiliated with any government agency. Download, Fill In And Print Application Form For Certified Copies Of Birth Certificate - City Of Bedford, Texas Pdf Online Here For Free. APPLICATION(S) FOR CERTIFICATE OF TITLE TO A MOTOR VEHICLE (Type or Print in Ink) CHECK TYPE OF APPLICATION(S) Fee of $5. We provide expert assistance and a secure online order form to help and assist in providing your information to the proper government office. Texas Death Certificate Blank Form Archives. $25 each certificate 1. mm dd yyyy. public birth certificate showing district should complete a Form BC-600 Application for Search of. PLEASE RETURN THIS FORM TO: VITAL RECORDS, 2600 SKYLAND DRIVE, NE, ATLANTA, GA 30319. Once the Application is complete, submit your application and fee to the office closest to where the ceremony occurs, either:. Fill, sign and download Income Certificate Form online on Handypdf. Please visit the Gender Designation Change on a Birth Certificate page to access instructions and forms. Average application processing time is 6-12 weeks. gov/ licensing/vital-records/index. 00 for each additional copy of the same record. Fast We have streamlined the vital records application process to allow you to request a birth certificate from any state in the U. applicants complete and submit this application and any other required documentation to the financial aid office on or before January 15. And you can do it all from anywhere on any device for a fraction of the cost. These include birth certificates, expired and. To create the affidavit, you must find a person with personal knowledge about your birth, and state how it was acquired. Report of Separation or Discharge, DD Form 214 (and DD Form 215 if the DD Form 214 has been amended) – To. Texas Death Certificate Blank Form Archives. Amending a Birth Certificate After a Court Order Name Change January 1, 2008 Upon request, this document will be made available in Braille, large print, and audiocassette or computer disk. NAME - Write your legal name in the spaces provided. Instead of uploading a proof of birth document with each player’s registration, please upload this completed form for each player. Recordable documents are issued by a Texas statewide officer. 7, Hawaii Revised Statutes (HRS), as amended by Act 226 (July 2015) establishes the documentation required when requesting the Department of Health to issue a new birth certificate with a sex designation change. Drivers' licenses, Social Security cards, passports and other government-issued documents rely on a birth certificate to verify information. State law restricts access to the registrant's. Answer the questions. Solicitud para acta de Nacimiento y Defuncion (Please have correct change / favor de tener el cambio correcto) 1. Upon completion of the form please mail or hand deliver to the address below, along with a copy of a valid State issued. b) If Child Name not included a separate form to be filled by the Father and Mother of the child 4. Request form for Hospitals, Birthing Centers, and/or Midwives:. Some people must pay a monthly fee to be in this program. You may obtain a certified copy of your birth certificate in person (with valid ID) at our office or through the mail by completing and mailing this form along with a copy of your driver's license or acceptable identification. MARRIAGE CERTIFICATES. 003) Please Print: Information Found on Birth Certificate 1. Order a copy of a birth, death or marriage certificate A Multilingual Standard Form (MSF) translates parts of a certificate so that fill in the relevant GRO certificate application and. Home | Registrar General's Department. Instructions to obtain a Texas BIRTH Certificate: Complete the section of the application labeled BIRTH. VITAL RECORDS. Reciprocal Electrical Journeyman 2-year license - $250. MOTHER’S CURRENT LEGAL NAME. Hello Sharon and thank you for your question. Birth Certificate Application Form Kenya. 2 Persons claiming Jamaican Citizenship by Descent MUST have their claim established BEFORE submitting the application for apassport. Application for Certificate Applicacion para Certificado Bureau of Vital Statistics INSTRUCTIONS DELAYS • Read all instructions carefully before completing application. Online order accepts Visa and MasterCard. This evidence includes a copy of the marriage certificate of the Applicant's parents, which shows that they were married in Texas in 2006. For notaries who are state employees (PDF). Full Name of Child 2. Can I use the birth certificate I received to obtain a passport, if I select the reason for my request is to obtain a passport? Yes, the certificates are official, raised seal - long form version certificates certified by the Texas Department of State Health Services accepted by all state and federal agencies suitable for obtaining a passport. 00 - 5 x 7 $21. Application for an Original Texas Driver License or Identification Card 2. To request a New Mexico birth or death certificate, click a certificate request form below. TEXAS WORKFORCE COMMISSION LABOR LAW SECTION 101 East 15th Street, Room 514, Austin, Texas 78778 Information about Certificate of Age. 1126 Fax: (830) 620-5518 APPLICATION FOR CERTIFIED COPY OF BIRTH OR DEATH RECORD Birth Certificate Please Print Death Certificate Number of Items Requested _____ Certified Copies x $23. Make sure to fill out the adult adoptee’s information in Section 1 as it currently appears on the adult adoptee’s birth certificate. Expedited delivery available. Processing time is subject to change, dependent on volume of incoming applications. TOTAL FEES DUE. It's proof of identity for many purposes, such as claiming government benefits, enrolling in school and applying for a passport or driver licence. We do not accept birth certificates and marriage certificates issued by the province of Quebec before January 1, 1994 in support of an application for a citizenship certificate. BIRTH NUMBER: CHI LD 1. citizenship certificate with photo • U. pdf - Free download Ebook, Handbook, Textbook, User Guide PDF files on the internet quickly and easily. See page 2 or visit. Birth/Death Certificate Outside of Dallas County but in Texas: The City of Dallas issues Birth Abstract certificates for births in Texas, but outside of the City of Dallas city limits. Easy and convenient By following our step-by-step instructions and completing the simple online application form, you can prepare your vital records application for any State in the U. Application for Certificate The penalty for knowingly making false statement on this form is a state of Texas. ONLY those listed on the birth certificate can request a copy and identification is required to obtain the record. please print clearly using blue or black ink. Reciprocal Electrical Journeyman 2-year license - $250. Birth Certificate. ITEM(S) ON ORIGINAL BIRTH CERTIFICATE TO BE CORRECTED. Copies of birth certificates for births that occurred within the past 75 years can be requested only by the immediate family of the person whose name is on the birth certificate. Sample Letter of Intent - Certificate of Need Application DC Health Telephone Directory Use our DC Health Service Telephone Directory to view the telephone numbers for various DC Health services. for a Texas Driver License or Identification Card. At least 1 of the following:. We need copies of the front and back of these forms. First, you must establish paternity and then submit the correct form to the Texas Vital Statistics office. 003) mail this sworn statement, application, payment, and a photocopy of your valid photo id to: brazoria county clerk. adult adoptee application. 2300 Bloomdale Road, Suite 2106. Recordable documents are issued by a Texas statewide officer. 00 must be paid for each copy of birth certificate and a single $2. The lists below are in accordance with Texas Department of State Health Services. at 1395 Eisenhower Drive (912-356-2138). If a prospective or current employer asks a child, ages 14 to 17, to furnish a Certificate of Age, the certificate may be obtained from the. All fees paid are non-refundable. Getting a Birth or Death Certificate. In this particular time period, We'll explain to you 50 new image collection in relation to 50 Sample Certificate Of Good Standing Texas. This form and the information provided are not substitutes for the advice and services of an attorney. Do not request two different types of certificates on the same form. To obtain a certified copy of your birth record or a certified copy of a death record, you must complete an Application form. The Wisconsin Vital Records Office is responsible for the collection and distribution of birth, death, marriage and divorce certificates. Considerations. A new birth certificate may be filed that incorporates the corrected sex of the person named on the birth certificate. I wish to make a $5 donation for the Texas Cas hC eck# Debi t/credi Home Visiting Program for healthy early childhood WARNING: The penalty for knowingly making a false statement on this form can be 2-10 years in prison and a fine of up to $10,000. - peruantitaurino. Texas Death Certificate Blank Form Archives. 34 Birth Certificate Form free download. DOH 422 -044 January 2019. failure to remove this page will result in additional recording fees by the county clerk.