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State Use Only Original SFN Amended SFN Envelope AFS Ohio Department of Health VITAL STATISTICS CHILD S PERSONAL DATA 1. D. D. O. C. N.M. Other Midwife Time of Birth Mailing Address Number Street City County State Zip Code Hospital/Birthing Facility Registrar s Name Date Filed by Registrar Month Day Year Parent s Current Mailing Address Attorney s Name and Address Street City or Village Probate Court Ross County Ohio I hereby certify that the child named above was adopted on Date by Name s of...
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