John Smith 123 Main Street Oaktown, MI 12345 06/17/2012 Sally Jones State Dept.

of Public Health 456 Central Ave Rockville, CT 67890 Re: Request for Birth Certificate To Whom It May Concern: Please forward to my attention 1 certified copy of the birth certificate for the following person: Full name: Sex: John Smith Male

To assist in locating and providing the requested certificate, I am including the following information: Father's full name: Chris James Mother's full name: Jill James Mother's maiden name: Jill Hull Date of birth: 05/13/1952 Place of birth: Hospital or Location: International Hospital City: Charleston County: USA State: Nevada I am the person whose record is being requested. This certificate is being requested to use in a family scrapbook Enclosed is my certified check in the amount of $10.00 as payment for the requested certificate. Please contact me at the above address if you have any questions or need additional information. Thank you for your prompt attention to this matter. Sincerely,

John Smith