Authorization To Release A Vital Record Form
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1Authorization to Release a Vital Record
Date: _______________________
I, _________________________, hereby authorize ______________________
(
(
name of person eligible for record)
name of person to obtain record)
to obtain the ___ birth, ____death ____ marriage record of _____________________.
(check all that apply)
(
name of person on record to be released)
_________________________________________
Signature
Personally appeared before me this _________ day of ___________________, 20 __,
at _________________, Maine, by __________________________ to be his/her free
)
(name of person acknowledged
act and deed.
______________________
Signature of Notary/Attorney
______________________
Printed Name of Notary/Attorney
______________________
Date Commission Expires
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Parent category: Business