I'm going to second Ghostcript - it seems I did look at it years ago but never made it work for me (I think it cost money that was not available for my company then).
I have it somewhere...
As the author of the PDF Toolkit, I had this question a lot. Best choice ever was to not include printing in the toolkit. This is a mess...
As this isn't source code, and also because I'm not that organized, the "ghostscript VI" probably lives on a HDD in an old laptop. It didn't make it to SCC.
My 2012 implementation that I eventually got working was ActiveX through a WebBrowser. (I think using AdobeX).
but a lot has changed in activeX support since then so there not even any point in digging out that code.
Good point. This one is pretty recent:
EDIT: Also attached it in LV13...
In some industries (defence and medical) the piece of paper can still be more important than the electronic record as it actually goes around with the unit and contains a record of any changes to it that can't be easily added / switched on an electronic system. It's difficult to get out of that space with more complex devices that take longer to test and sign off - so it's possible.
Here is the same result, direct print, with Ghostscript 😉