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Vital Statistics Office. A certified copy will be provided to you for a fee. You can use the certified copy as proof that you have chosen to use your spouse s surname. Help note 1 A. Information about the person applying (See help note 1 on the left) Print the name you use now. What is your first name? Surname is your last name or family name. What are your middle names? Gender (M/F) What is your surname (last name or family name)? Birth Date - mm/dd/yy Mailing Address: (stre.

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