ࡱ> -/, bjbj 4      ) .=====; HHH  ==   H = = H   =[M°R 0  hv   ^ LF. HHHH :  APPLICATION FOR A CERTIFIED COPY OF A BIRTH RECORD $15.00 FIRST COPY, $6.00 EACH ADDITIONAL COPY **$2.00 MAILING FEE OR SEND A SELF ADDRESSED STAMPED ENVELOPE WITH YOUR REQUEST** MAKE CHECKS PAYABLE TO: TOWN OF HOULTON NAME AT BIRTH _______________________________________________________ DATE OF BIRTH ________________________________________________________ TOWN OF BIRTH _______________________________________________________ FATHERS FULL NAME __________________________________________________ MOTHERS FULL MAIDEN NAME _________________________________________ YOUR NAME ______________________________________ YOUR RELATIONSHIP TO PERSON NAMED ABOVE _________________________________ If you are not specifically named on the birth certificate, you must include proof of direct and legitimate interest (ex. marriage license). YOUR MAILING ADDRESS _______________________________________________ YOUR PHONE # _________________________________________________________ SIGNATURE OF APPLICANT ______________________________________________ NUMBER OF COPIES _______________ TODAYS DATE _____________________ For additional information, please contact the Town of Houlton at (207) 532-7111. --------------------------------------------------------------------------------------------------------------------------------------- **Please be advised that anyone purchasing a copy of a record must show proof of identification (drivers license, passport or other government issued picture identification card). If these are not available, then the applicant will need to show two items from the following list: utility bills, bank statements, car registration, copy of income tax return, personal check with address, a previously issued vital record, a letter from a government agency requesting the vital record (DHS,WIC), Department of Corrections ID Card, Social Security card, DD214 form, hospital birth worksheet, license/rental agreement, pay stub or W-2, voter registration card, Medicare/Mainecare insurance card, private or public school photo ID, college photo ID, employee photo ID, or a disability award letter for SSA. These identification requirements apply to both certified and non-certified copies of vital records. 568<IMafnE  7 N % i j C D F fÿӻӷ˳ӯӜ}v h qhQh2ehQ5CJaJh3CJaJh2ehQCJaJhQCJaJh07 h qh qh qh)&Qh?Fhth!hMhH29h$hbh~hUr'hF8CJ aJ hUr'h~CJ aJ hUr'hghUr'hg5hg%678* + r s  D E F w x O gd$ &dP$a$gdUr'O # $ % i j D gdQgdgd qgd$ 21h:p8q/ =!"#$% ^ 666666666vvvvvvvvv666666>6666666666666666666666666666666666666666666666666hH6666666666666666666666666666666666666666666666666666666666666666662 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~_HmH nH sH tH @`@ NormalCJ_HaJmH sH tH DA D Default Paragraph FontRiR  Table Normal4 l4a (k (No List HH ;XR Balloon TextCJOJQJ^JaJPK![Content_Types].xmlj0Eжr(΢Iw},-j4 wP-t#bΙ{UTU^hd}㨫)*1P' ^W0)T9<l#$yi};~@(Hu* Dנz/0ǰ $ X3aZ,D0j~3߶b~i>3\`?/[G\!-Rk.sԻ..a濭?PK!֧6 _rels/.relsj0 }Q%v/C/}(h"O = C?hv=Ʌ%[xp{۵_Pѣ<1H0ORBdJE4b$q_6LR7`0̞O,En7Lib/SeеPK!kytheme/theme/themeManager.xml M @}w7c(EbˮCAǠҟ7՛K Y, e.|,H,lxɴIsQ}#Ր ֵ+!,^$j=GW)E+& 8PK!Ptheme/theme/theme1.xmlYOo6w toc'vuر-MniP@I}úama[إ4:lЯGRX^6؊>$ !)O^rC$y@/yH*񄴽)޵߻UDb`}"qۋJחX^)I`nEp)liV[]1M<OP6r=zgbIguSebORD۫qu gZo~ٺlAplxpT0+[}`jzAV2Fi@qv֬5\|ʜ̭NleXdsjcs7f W+Ն7`g ȘJj|h(KD- dXiJ؇(x$( :;˹! I_TS 1?E??ZBΪmU/?~xY'y5g&΋/ɋ>GMGeD3Vq%'#q$8K)fw9:ĵ x}rxwr:\TZaG*y8IjbRc|XŻǿI u3KGnD1NIBs RuK>V.EL+M2#'fi ~V vl{u8zH *:(W☕ ~JTe\O*tHGHY}KNP*ݾ˦TѼ9/#A7qZ$*c?qUnwN%Oi4 =3ڗP 1Pm \\9Mؓ2aD];Yt\[x]}Wr|]g- eW )6-rCSj id DЇAΜIqbJ#x꺃 6k#ASh&ʌt(Q%p%m&]caSl=X\P1Mh9MVdDAaVB[݈fJíP|8 քAV^f Hn- "d>znNJ ة>b&2vKyϼD:,AGm\nziÙ.uχYC6OMf3or$5NHT[XF64T,ќM0E)`#5XY`פ;%1U٥m;R>QD DcpU'&LE/pm%]8firS4d 7y\`JnίI R3U~7+׸#m qBiDi*L69mY&iHE=(K&N!V.KeLDĕ{D vEꦚdeNƟe(MN9ߜR6&3(a/DUz<{ˊYȳV)9Z[4^n5!J?Q3eBoCM m<.vpIYfZY_p[=al-Y}Nc͙ŋ4vfavl'SA8|*u{-ߟ0%M07%<ҍPK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-![Content_Types].xmlPK-!֧6 +_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!Ptheme/theme/theme1.xmlPK-! ѐ' theme/theme/_rels/themeManager.xml.relsPK]   O  8@0(  B S  ? (d ($  ( !( "($ #( $($ %( &(d Ea{{#Ie8*urn:schemas-microsoft-com:office:smarttagsCity9*urn:schemas-microsoft-com:office:smarttagsplace? *urn:schemas-microsoft-com:office:smarttags stockticker I :<LMafD$jnvz!S% Mb&!Ur',8F8H29\@?F)&Q;XR 6j]Pl qmw9{tO{~Qg07$t^v38q@X@UnknownG*Ax Times New Roman5Symbol3. *Cx Arial5. .[`)TahomaA$BCambria Math"h*(G*(GP}P}Yr43KP ?tO{2!xx2APPLICATION FOR A CERTIFIED COPY OF A BIRTH RECORDPreferred CustomerlaurenOh+'0|   , 8 D P\dlt4APPLICATION FOR A CERTIFIED COPY OF A BIRTH RECORDPreferred CustomerNormallauren2Microsoft Office Word@F#@Z߯@RTB°@RTB°P}՜.+,0( hp  Town Of Houlton 3APPLICATION FOR A CERTIFIED COPY OF A BIRTH RECORD Title  !"#%&'()*+.Root Entry FM°01Table WordDocument4SummaryInformation(DocumentSummaryInformation8$CompObjy  F'Microsoft Office Word 97-2003 Document MSWordDocWord.Document.89q