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Get Form 1a Birth Certificate

TRATION NUMBER US E BL A CK INK ON LY 1B. MIDDLE 1A. NAME OF CHILD - FIRST 4A. DATE OF BIRTH - MM/DD/CCYY 5B. STREET ADDRESS - STREET AND NUMBER, OR LOCATION 5C. CITY 5D. COUNTY 6A. NAME OF FATHER/PARENT - FIRST 6B. MIDDLE 6C. LAST 7. BIRTHPLACE - STATE/ COUNTRY 9A. NAME OF MOTHER/PARENT - FIRST 9B. MIDDLE 9C. LAST - BIRTH NAME 10. BIRTHPLACE - STATE/ COUNTRY 8. DATE OF BIRTH - MM/DD/CCYY M PL E LOCAL REGISTRAR INFORMANT AND BIRTH CERTIFICATION MOTHER/ PARENT FATHER/ PARENT.

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