AGENCY: Davis County (Utah). Health Department. Administration Division

SERIES: 11073
TITLE: Vital statistics amendment affidavit
DATES: undated.
ARRANGEMENT: None

DESCRIPTION: This is a state form used to amend a birth, death, or fetal death certificate. This completed form is sent to the State Health Department and after its final approval it becomes part of the original state record and a copy is returned to the local health department. The form includes local certificate number, indication whether birth, death, or fetal death certificate, state certificate number, name, sex, event date and place, names of father and mother, facts on original records and facts as they should have been stated at time of occurrence, and notarized signatures of two witnesses.

RETENTION

DISPOSITION

RETENTION AND DISPOSITION AUTHORIZATION

Retention and disposition for this series is proposed and has not yet been approved.

FORMAT MANAGEMENT

Paper: Retain in Office until administrative need ends and then destroy.

Computer data files: Retain in Office until administrative need ends and then delete.

APPRAISAL

Administrative

PRIMARY DESIGNATION

Public

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