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Get MA R-109 2016-2024

-CERTIFIED RECORD OF BIRTH PRIOR TO ADOPTION (Please print legibly.) Completed_________ #_________________ Cert #_____________ Initials_____________ Please fill out and return this form to the address above. If you are requesting a record by mail, make your check or money order payable to the Commonwealth of Massachusetts and include $32.00 for each copy requested. DO NOT SEND CASH THROUGH THE MAIL. Records requested in-person at the Registry counter are $20.00 per copy. Checks, money orders.

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