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Get Ny Vr 67 2002

TION FOR A BIRTH RECORD (Print All Items Clearly) 1. LAST NAME ON BIRTH RECORD 2. FIRST NAME 3. ❏ FEMALE ❏ 4. DATE OF BIRTH Month 5. PLACE OF BIRTH (NAME OF HOSPITAL, OR IF AT HOME, NO. AND STREET) Day Year 7. MOTHER'S MAIDEN NAME 8. CERTIFICATE NUMBER (IF KNOWN) (NAME BEFORE MARRIAGE) FIRST LAST 9. FATHER'S NAME (FOR OFFICE USE ONLY) FIRST 10. NO. OF COPIES MALE 6. BOROUGH OF BIRTH LAST 11. YOUR RELATIONSHIP TO PERSON NAMED ON BIRTH RECORD IF SELF, STATE “SELF” 12. F.

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