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Get CT VS-39DTW 2011-2024

O NOT MAIL CASH OR PERSONAL CHECKS SEX M F Full Name of Deceased: (First, Middle, Last): Date of Death: (Month/Day/Yr): * Town of Death: Date of Birth (Month/Day/Yr): Place of Birth (Town, State or Country): Father’s Name: Mother’s Name: If Married, Spouse’s Name: Person Requesting the Death Certificate: Name: _ _____________________________________________________________________________________________________ First Middle Last Name Address: __________________________________.

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