Donor Registry Enrollment Form
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Donor Registry Enrollment Form. This is a Ohio form and can be use in Bureau Of Motor Vehicles Statewide.
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Tags: Donor Registry Enrollment Form, BMV 3346, Ohio Statewide, Bureau Of Motor Vehicles
DONOR REGISTRY ENROLLMENT FORM
To register, please complete and mail this enrollment form to:
Ohio Bureau of Motor Vehicles
Attn: Records Request Unit
P.O. Box 16520
Columbus, Ohio 43216-6520
Yes, I want to join the Donor Registry!
Please take me out of the Donor Registry.
ANATOMICAL GIFT OF (Print or type name of living donor)
In the hope that I may help others upon my death, I hereby give the following body parts:
(Specify all organs/tissues to be donated, or indicate “all”)
for any purpose authorized by law: transplantation, therapy, research, education, or
advancement of medical or dental science.
Signed by the donor and the following two witnesses in the presence of each other:
SIGNATURE OF DONOR
DATE SIGNED
X
DATE OF BIRTH OF DONOR
SOCIAL SECURITY NUMBER
DRIVER LICENSE OR ID NUMBER
WITNESS
X
WITNESS
X
This is a legal document under the Uniform Anatomical Gift Act or similar Laws.
BMV 3346 5/08
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