English extract translation of language birth certificate name of registered child: date of birth: place of birth: father of child: age of father: nationality of father: mother of child: age of mother: nationality of mother: paternal grandparents:...
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Patient registration patient referred by todays date patient name soc. sec. #. street address date of birth age city/state zip tel #. cell #. email address father / guardian information name marital status s m w sep d street address city/state zip...
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For office use only pick up/mailed public health and social services department 412 lilly road n.e. olympia, wa 98506-5132 (360) 786-5581, ext. 16913# application for birth certificate 1. fill out the information listed below: full name at birth...
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South carolina native plant society 2015 symposium felix c. davis community center, north charleston, sc june 1214, 2015 please note: the deadline for registration is june 5, 2015. a $10 fee will be added to any registrations at the door and a box...
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Mail application, proof of identity, self addressed stamped envelope, and fee to: town of rumford 145 congress street rumford, maine 04276 2073643001 x 213 fax 2073645642 st $15 for 1 copy, $6 for each additional copy / checks payable to: town of...
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The kings preschool registration form 2013/2014 please print clearly: name of child: home number: home address: town: zip code: childs date of birth: age: years months fathers name: work #: cell #: mothers name: work #: cell #: preferred email...
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National hybrid registry application for the registration 0f a whole litter po box 309 blaine tn 37709 865-932-9807 fee for registration: $13.00 for a litter of 7 puppies or less, and add additional $1.00 for each puppy over 7. add $10.00 to...
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