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Get KY VS-37 2012

1911 are on file in this office Please Print or Type All Information Required On This Form BIRTH CERTIFICATE INFORMATION First 1. Full Name at Birth Month 2. Date of Birth 3. Place of Birth Middle Day Last Year Sex Age Last Birthday Kentucky City or Town Kentucky County Name of Hospital First Middle Last First Middle Last 4. Mother’s Maiden Name 5. Father’s Name If this child has been adopted, please give original name if known: __________________________________________.

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