Fillable DEPARTMENT OF HEALTH AND FAMILY SERVICES STATE OF ... - wrdaonline

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DEPARTMENT OF HEALTH SERVICES Division of Public Health F-05280 LVRO (Rev. 03/10) STATE OF WISCONSIN Chapter 69.21 Wis.Stats. Page 1 of 2 WISCONSIN DEATH CERTIFICATE APPLICATION (for Mail or In-Person Requests) TYPE or PRINT. PENALTIES: Any person who willfully and knowingly makes a false application for a death certificate is guilty of a Class I felony a fine of not more than $10,000 or imprisonment of not more...
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