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StateofCaliforniaHealthandHumanServicesAgency CaliforniaDepartmentofPublicHealth APPLICATIONFORCERTIFIEDCOPYOFDEATHRECORD PLEASEREADTHEINSTRUCTIONSONPAGE2BEFORECOMPLETINGTHISAPPLICATION Aspartofstatewideeffortstopreventidentitytheft,Californialaw(HealthandSafetyCodeSection103526)permitsonlyauthorizedindividualsaslistedonthe.

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