CERTIFICATION OF BIRTH
STATE FILE NUMBER: 109-1962-200000
CHILD’S NAME: SAMPLE SAMPLE SAMPLE
DATE OF BIRTH: DECEMBER 30,1962
SEX: FEMALE
COUNTY OF BIRTH: DUVAL
DATE FILED: DECEMBER 30,1962
MOTHER’S MAIDEN NAME: SAMPLE SAMPLE SAMPLE
DATE ISSUED: MARCH 22,2005
