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Get Nys Doh 4384

Print the completed form sign and mail to the address shown above. You can print out a blank copy of the form and then type or print the required information. Be sure to sign the form before mailing and include a check or money order made payable to the New York State Department of Health along with copies of any required documentation. DOH-4384 12/05 Page 1 of 2 VITAL RECORDS COPIES CANNOT BE PROVIDED FOR COMMERCIAL PURPOSES. Return to New York .

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