BIRTH CERTIFICATE

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BIRTH CERTIFICATE

____________________________________

(last name, first name, patronymic name)

Born on______________________________________

(date, month, year (in figures and words))

Place of birth____________the city of Nizhny Novgorod____________________________

in witness whereof an entry under No. *** was made on *** in the Birth Register.

Father:______________________

____________________________________

(last name, first name, patronymic name)

Citizen of Russia

(citizenship)

____Russian__________________________________________

nationality (entered at father’s will)

Mother:____________________________

(last name, first name, patronymic name)

Citizen of Russia

(citizenship)

____Russian__________________________________________

nationality (entered at father’s will)

Place of the state registration__Civil Status Registry Office of Sovetsky district of the city ofNizhny Novgorod_________________________________________________________

(Name of the Department/Division of the Civil Status Registry Office)

Date of issue

Head of the Department/Division of the Civil Status Registry Office /Signature/ ***

I-TH No. ***

/Seal: the Main Directorate of Civil Status Registry Offices for Nizhny Novgorod Region, Civil Status Registry Office of Sovetsky district of the city Nizhny Novgorod/

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