"This is to certify that this is a true and correct reproduction or abstract of the official record filed with the...................Department of Health,......................, Virginia.
Date issued...................
.................................... Registrar"
The registrar will enter the appropriate city or county name in the spaces provided, date and sign the certification, and enter his official title.
12 Va. Admin. Code § 5-550-510
Statutory Authority
§§ 32.1-12 and 32.1-250 of the Code of Virginia.