MMIR memorial

Instructions

Complete the information below to have your loved one included in the Missing and Murdered Indigenous Relatives Office Minnesota MMIR memorial. Once the firm is complete, your information will be incorporated in to the memorial within 30 days.

Please be aware that this is not a case intake.

In order to receive services from the MMIR Office, you must complete an intake form.
Requester information
Name

First NameLast Name
Phone number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Victim or missing person information
Victim’s name*

First nameMiddle nameLast name
Victim’s date of birth*

MonthDayYear
Date
Is missingWas murdered
YesNo
YesNo
Please upload if you would like to submit a photo

Cancelof
Acknowledgement

By submitting this form, I certify the following:

All statements and information made by me in this document are true, complete, correct to the best of my knowledge, and are made by me in good faith.

All information provided is for awareness purposes only. I understand that this is not a case intake and my case will not be registered with the MMIR Office.

I grant permission and give my consent to the Minnesota Department of Public Safety, to use photograph(s) or electronic media I have submitted. I understand the images may be used in print publications, online publications, presentations, websites, and social media. I understand that no royalty, fee or other compensation shall become payable to me by reason of such use.
Please verify that you are human*
Should be Empty:

Requester information

Victim or missing person information