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Es, or on an application for an amendment thereof, commits a felony of the third degree, punishable as provided in s. 775.084, Florida Statutes. 1. 2. 3. Complete only the upper half of the affidavit. This affidavit will be attached to the original birth certificate thus becoming part of the birth record. Therefore, when completing, please use black typewriter ribbon or print clearly using black ink. a. REGISTRANT S FULL NAME AT BIRTH Enter the registrant s (person for whom the record.

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