ࡱ> ac`q` -bjbjqPqP 4:::]44448<4\&&>~$X%%%%%%%$d'h)%-"%44%^448%%4l 7'-I^$%0&&f*f*f*l(vTD6(((%%^(((&&<<444444 The State of New Hampshire City of Franklin Application for Copy of Death CertificateOFFICE USE ONLY DATE:  FORMTEXT       # REQ.:  FORMTEXT       Amt. Paid:  FORMTEXT      Please Print Plainly :& Name of Deceased:First:  FORMTEXT       Middle:  FORMTEXT       Last:  FORMTEXT      Place of Death: FORMTEXT      Date of Death: FORMTEXT      Purpose for which certificate is requested:  FORMTEXT      Requestors Name:First:  FORMTEXT       MI:  FORMTEXT       Last:  FORMTEXT      Relationship: FORMTEXT      Address: Number:  FORMTEXT       PO Box  FORMTEXT       City:  FORMTEXT       State:  FORMTEXT    Zip:     . 0 2 < > Z \ p r t ~ ufjhqThzRHCJUaJhqThCJaJhzRHCJOJQJ^JaJ hqTheCJOJQJ^JaJhqTheCJaJjhXUjthXUjhzRHUmHnHujhXUjhzRHUhzRHhWCJaJh#CJaJhqThzRHCJaJ#6X @ ojjgdaIzkd\$$Ifl0,"  t0644 la $IfgdaI $$Ifa$gdzRH -0--   0 2 F H J T V r t    ʾʬʾʈ}u}}c}u}}#jhqThXCJUaJh#CJaJhqThzRHCJaJ#jhWhXCJUaJ"jhWCJUaJmHnHu#jYhWhXCJUaJjhWCJUaJhWCJaJjhCJUaJjhqThzRHCJUaJ#jhqThXCJUaJ" {zkdE$$Ifl0@ ,"  t0644 la $IfgdaI  , {{ $IfgdaIzkdB$$Ifl0@ ,"  t0644 la   ( * . > l ~    $ & : ޾ucu#jhqThCJUaJ(jhqThCJUaJmHnHu#jhqThCJUaJjhqThCJUaJhCJaJhqThCJaJhqThzRHCJaJ(jhqThzRHCJUaJmHnHujhqThzRHCJUaJ#jhqThXCJUaJ, . {rr $IfgdaI $IfgdXzkd?$$Ifl0@ ,"  t0644 la {{ $IfgdaIzkd<$$Ifl0@ ,"  t0644 la: < > H J ` b v x z     6 8 L N P Z \ n p ޾޾޾޾޾޾޾޾n޾޾#j% hqThCJUaJ#j hqThCJUaJ#jhqThCJUaJhCJaJ#jhqThCJUaJhqThCJaJ(jhqThCJUaJmHnHujhqThCJUaJ#j;hqThCJUaJ% {{ $IfgdaIzkd'$$Ifl0@ ,"  t0644 la ^ ` &({{{{{ $IfgdaIzkd& $$Ifl0@ ,"  t0644 la (((("($(B(D(X(Z(\(b(d(f(h(|(~(޾ބr޾޾`޾޾N#j hqThCJUaJ#j hqThCJUaJ#j hqThCJUaJU"jhCJUaJmHnHu#j hwahCJUaJhCJaJjhCJUaJhqThCJaJ(jhqThCJUaJmHnHujhqThCJUaJ#j hqThCJUaJ FORMTEXT      Telephone #: FORMTEXT    - FORMTEXT    - FORMTEXT      Signature of Requestor: Notice: Any person shall be guilty of a Class B felony if he/she willfully and knowingly makes any false statement in an application for certified copy of a vital record. (RSA 126:24) New Hampshire Fees RSA 126:13 & 15 The fee for each search is $12.00. The fee shall be changed whether or not the record is located and includes one certified copy of the record, if located. Additional certified copies issued at the same time as the initial copy are $8.00 each. Also enclose a photocopy of your Photo Identification.      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