Pennsylvania Department of Health ♦ Division of Vital ...
Pennsylvania Department of Health ♦ Division of Vital Records H PART 1: By my signature below, I state I am the person whom I represent myself to be herein, and I affirm the information within this form is complete and accurate and made subject to the penalties of 18 Pa.C.S. §4904 relating to unsworn falsification to authorities. In addition ... ................
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