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Get LA DHH/OPH/Vital Records Packet 18 2004-2022

Last First Middle . . . Street Address: Tel. No. . State: Zip Code: . City: Signature: Relationship to Registrant . . . . . . . . . . . . . . . . . . PART I. ENTER NAME, DATE AND PLACE OF BIRTH OF CHILD, AND NAMES OF PARENTS AS SHOWN ON BIRTH CERTIFICATE. IF THE CHILD S NAME DOES NOT AP.

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