Family MO HealthNet (MAGI) Manual – Table of Contents

1802.020.10 Signing By Mark

IM-#134, November 14, 2017

If the signature is by mark, two witnesses are necessary. If the signature is made by mark, the mark should be identified as such and enclosed in parenthesis with the claimant’s name written or typed as shown. The signature and address of the two witnesses should be entered in the space provided.

EXAMPLE:  First name, middle initial, last name, address.

Witnesses:   Jane Smith, 123 Sunrise St. Louis, MO 63108
John Smith, 123 Sunrise St. Louis, MO 63108