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(Date of Letter)

The Honorable (Governor, Secretary of State, Attorney General, etc.) (Room, Floor or P.O. Box) (Government Office Building) (Street Address) (City, State and Zip Code) RE: Attn: Birth Certificate Bureau of Vital Statistics

Dear Bureau of Vital Statistics: Presently, the undersigned is in need of a birth certificate for (name of individual for whom the birth certificate is sought). It is understood that the official date of birth was the day of , (year), and the place of birth was (city), (state). The official name given at birth was (name known to be given at time of birth). Kindly provide to the undersigned (number of) certified copies of the birth certificate of the aforementioned individual. Please understand that the birth date and name are provided to the best of my (our) knowledge or recollection; however, there might be some variation to the name, and the date might not be exact. Please indicate if there is any charge for the certified copies and, if so, contact the undersigned immediately whereupon remittance will directly follow. Should your office need any additional information, please advise. Thank you. Very truly yours,

(Signature) (Address) (City, State and Zip Code) (Phone Number) LAWCHEK, LTD. LETTER PRO Samples, Copyright 2000 This is not a substitute for legal advice. An attorney must be consulted.