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DEPARTMENT OF HEALTH SERVICES Division of Public Health F05280 LVR (Rev. 12/11) STATE OF WISCONSIN Chapter 69.21 Wis.Stats. Page 1 of 2 WISCONSIN DEATH CERTIFICATE APPLICATION (for Mail or Unperson
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What is MAIL TO ADDRESS (if different than street address)Apt template Form?

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The mail to address is the designated address where mail should be sent.
Any individual or entity that needs to receive mail at a specific address.
The mail to address should be filled out with the recipient's name, street address, city, state, and zip code.
The purpose of the mail to address is to ensure that mail is delivered to the correct recipient in a timely manner.
The mail to address must include accurate and up-to-date contact information for the recipient.
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