Report Your GAVERS Issue Below
First Name
Last Name
Email
Phone
Ext
Is This a Ticket Resubmission?	-None- Yes No
If Yes, Provide Previous Ticket Number
Record Date of Event  (ex: date of birth)
What is Your Primary Role?	-None- Funeral Home Staff County Vital Records Staff Birth/Fetal Death Registration Staff Death Medical Certifier Registration Staff ITOP Facility Registration Staff Coroner/Medical Examiner Staff State/Federal Agency Staff Other Role Not Listed
How Can We Help You?	-None- Illegible or Incomplete Certificate Un-Flag A Certificate Unable to Locate a Certificate in GAVERS GAVERS New User Registration or Add a Location to an Existing Account GAVERS Account Password Reset Add Place of Death/Disposition/Other Facility Add a New City/Zip Code/County Add Pronouncer or Certifier Add a Funeral Director Correction or Amendments – Must Mail-in Request Fee and Issuance Technical Issues Other GAVERS Technical Issues
Subject
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