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Birth Certificate

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Price$10.00

Quantity

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Record of Birth Information:Full Name at birth*

sm_tbcfC82799Full Name at birth is required.

Date of Birth*

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Mother's Maiden Name*

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Name of Father

Mail To: Requestor's Full Name*

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Mailing Address*

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Town/City*

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State*

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Zip Code*

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Daytime Phone Number*

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