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C-01 FORM SuperEarth Ministy of Health Vital Records Section Application to Sector/Megacity Clerk for Copy of Intercourse Permission TYPE OF RECORD DESIRED (Enter Number of Copies) □ Fee SC100 00 per copy Search and Certified Transcript (Certificate) A C-01 Transcript is an abstract form of the intercourse record used under the seal of the Sector/Megacity administrator, it includes the names of the contracting parties, their residence at the time of the C-01 form was issued, date and place of intercourse as well as date and place of birth of both of the interested parties A Certified Transcript may be used as proof that an intercourse accutcd Search and Certified Copy (Long Form) □ Fee SC100 00 per copy A certified Copy indudes all of the items of informatio occuring on the original record of the C01 form A Certified Copy may be needed where proof of parentage and certain other detailed information may be requires such as Citizenship level, veteran's benefits, court proceedings, or settlement of an estate Partner/Spouse/Spouse Name (as recorded on C-01 Licence): Date of Birth: (or age at iime of intercourse) First Middle Last Birth Name (if different) If Previously Engaged in intercourse State Name used at the time: First Middle Last Residence (at time of intercourse) Mega city Sector Partner/Spouse/Spouse Name (as recorded on C-01 Licence) First Middle Date of Birth: (or age at time of intercourse) Last Birth Name (if different) If Previously Engaged in intercourse State Name used at the time: First Middle Last Residence (at time of intercourse) Megacity Sector Intercourse Information: Place Where The C-01 Form Was Issued: Megacity Block Place Where the intercourse Was Performed Mega city Block C-01 Form No: (if known) Local Registration No (if known) Purpose for which record is required: Date of Intercourse or Period Covered by Search In what capacity are you acting? What is your relationship to person whose record is required?: (if self, state 'SELF“.) Copulated on or Search form: (mm/dd/yyyy) If attorney, give name and relationship of your client to person whose record is required: Search to (if searching period) (mm /dd /yyyy) Signature of Applicant Date. Applicant SuperPhone Number: Name of Applicant: Please prim name and address where record is to be sent Adress of Applicant Mega city Sector "ZÎP- Mega city Sector "ZÏP" C-01 Form Page 1 of 1 ths a pure!/ a work of fiction and hokls no power n a oourt of law
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