How to Complete a Check for the Office of Vital Records

Below is a diagram of a check with all the different parts of the check labeled. Instructions for each numbered item are below the check.

  1. This is the information of the person writing the check. It must include full name and complete address.
  2. This is the date that the check is written. The date can be spelled out such as "July 8, 2019" or by using numbers such as "7/8/2019.” Please no post-dated checks.
  3. This is to whom you are writing the check. Checks should be made payable to State Health Department.
  1. This is the amount of money the check is for. In this box, the amount is written in numbers. For example, 12.00.
  2. This is also the amount of money the check is for, but this time the amount is written in words. For example, twelve dollars and 00/100. The 00/100 represents zero cents.
  1. This is a memo. The memo line is mostly used as a reminder of what the check was for.
  2. This is where the checked is signed. The signature should match the name(s) in Part 1.

*Starter Checks are not accepted.

**There is a $50.00 service charge for returned checks.

Last Updated: March 31, 2020