Fraktur Order Form
Birth Certificate
Name of Child:  
Date of Birth:  
City:  
County:  
State:  
Weight:  
Length:  
Time:  
Mother (maiden name optional):  
Father:  

***********************************************
Ordered by:  
Address:  
City:  
State:  
Zip:  
Phone:  
Email:  

   

Folk Art by Chris Wert
409 Governor Drive
Shillington, PA 19607
610 775-7571
 chriswertfolkart@aol.com

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