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Get SC DHEC 0682 2015-2022

BIRTH CERTIFICATE (If Different) 3. DATE OF BIRTH (Month, Day, Year) 4. PLACE OF BIRTH (State or Foreign Country) 5.  RESIDENCE (County, State/Country) 6. NUMBER OF THIS MARRIAGE - First, Second, etc. (Specify) 7.  DEFENDANT (First, Middle, Last, Suffix) 8.  LAST NAME ON BIRTH CERTIFICATE (If Different) 9. DATE OF BIRTH (Month, Day, Year) 10. PLACE OF BIRTH (State or Foreign Country) 11.  RESIDENCE (County, State/Country) 12.  NUMBER OF THIS MARRIAGE- First, Second.

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