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Get MN IC 140-0163 2013

___________________ Instructions, please complete: Box 1 to certify the child’s immunization status Box 2 to file an exemption (medical or concientious) 1. Certify Immunization Status. Complete A or B to indicate child’s immunization status. A. Children who are 15 months or older: B. Children who are 15 months or younger: For children who are 15 months or older and who have received all the immunizations required by law for child care: For children who are younger than 15 months .

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