Request for Copy of |
|
Mailing Address Please print your name and address clearly. This portion will be used when mailing your certificate |
Name | ||
Address | Apt. No. | |
City | Province | Postal Code |
Tel. No. - Business | Tel. No. - Home |
Payment | Fees $12.00 x ___ # of Records = $_______ Total Fees Submitted Please note, RUSH service is not available when requesting copies of Genealogy Records |
1. Cash or Debit Card(in person only) or 2. Enclosed is a cheque/money order for $ _____ payable to the Minister of Finance or 3. Enclosed is a/are gift certificate(s) for $ _____ or 4. Credit Card       MasterCard       Visa Card/Number       Expiry Date: _________________________________________________________ Name on Card (please print) ____________________________________________ Signature of Cardholder: |
Vital Statistics Branch 254 Portage Avenue Winnipeg MB  R3C 0B6 Canada | |||
Inquiries: |
Telephone Toll-Free Fax |
204-945-3701 1-866-949-9296 204-948-3128 vitalstats@gov.mb.ca |