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Get Sc Dhec-0670c 2004

NDER 1 YEAR Months Days 4c. UNDER 1 DAY Hours Minutes Yes No 6. BIRTHPLACE (City and State or Foreign Country) (MM/DD/YYYY) 7b. COUNTY 7c. CITY OR TOWN 7d. STREET AND NUMBER 8. EVER IN US ARMED FORCES? 5. DATE OF BIRTH 3. SOCIAL SECURITY NUMBER 7e. APT. NO. 7f. ZIP CODE 7g. INSIDE CITY LIMITS? Yes No 9. MARITAL STATUS AT TIME OF DEATH 10. SURVIVING SPOUSE'S NAME (If wife, give name prior to first marriage) Married Married, but separated Widowed Divorced Never Married Unknown 11. F.

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