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REQUEST FOR CERTIFIED COPY OF BIRTH CERTIFICATE |
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Name:___________________________________________________ Date of Birth:______________________________________________ Birthplace:________________________________________________ Father's Name:_____________________________________________ Mother's First and Maiden Name: ______________________________ Person Requesting This Copy: _________________________________ Date:__________ Signature: X_________________________________ Photo Copy Street, of I. D. P.O. Box or R. R # _________________________
City: _____________________ State:_______ |
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