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2. Type of Record*
   -- Select One --BirthDeathMarriage

   Please select which record you are requesting
4. Name of Person to be Searched*
   First and last name
6. Year*
   -- Select One --188518861887188818891890189118921893189418951896189718981899190019011902190319041905190619071908190919101911

   Please select the year, month and day of the birth, marriage or death.
7. Month
   -- Select One --JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember
8. Day
   -- Select One --12345678910111213141516171819202122232425262728293031
10. Your Name*
    Please put your name so we know who we are contacting with the information found.
12. Email Address*
    This is the email address that will be used to contact you with the information found in the request. If an email address is not submitted there is no way to contact you with the information found.
14. Additional Information
    Please supply any additional information that would assist in the search of the record you are requesting.
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16. 1. Receive an email copy of this form.
17. Email address

    This field is not part of the form submission.

18. Submit

* indicates a required field