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Get SC DHEC 0682 2015

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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