James Smith 8 Hayes St San Rafael, CA 94901 February 22, 2012 Ryan Plum The Vital Statistics Office

1234 Gold St San Rafael, CA 94901 Re: Request for Death Certificate To Whom It May Concern: Please forward to my attention 1 certified copy of the death certificate for the following person: - Full name: Sam King - Sex: Male To assist in locating and providing the requested certificate, I am including the following information: Father's full name: Ben King Mother's full name: Lauren King Mother's maiden name: Write Date of death: January 04, 2012 Place of death: - Location: Saint Marks Hospital - City: San Rafael - County: Marin - State: California I am the Uncle of 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 $25.00 as payment for the requested certificate. Please contact me if you have any questions or need additional information. I can be contacted by phone at (415)443-4355 or (415)435-2234.

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Thank you for your prompt attention to this matter. Sincerely,

James Smith

This is a RocketLawyer.com Legal Document