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Get Virginia Birth Certificate 2019-2024

Ions: The requester - the person submitting this application - must show an acceptable identification document(s) from the list on the back of this form and provide payment to the Department of Motor Vehicles (DMV). REVIEW PAYMENT INFORMATION on page 2 of this form. REQUESTER INFORMATION REQUESTER NAME (print) - (last) (first) REQUESTER ADDRESS (middle) (suffix) CITY SEX STATE REQUESTER EMAIL MALE ZIP CODE TELEPHONE NUMBER ( FEMALE ) RELATIONSHIP OF REQUESTER TO PERSON NAMED ON.

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