ENGLISH EXTRACT TRANSLATION OF __________________ LANGUAGE

BIRTH CERTIFICATE
Name of Registered Child: __________________________________________
Date of Birth:
__________________________________________
Place of Birth:
__________________________________________

Father of Child:
Age of Father:
Nationality of Father:

__________________________________________
__________________________________________
__________________________________________

Mother of Child:
Age of Mother:
Nationality of Mother:

__________________________________________
__________________________________________
__________________________________________

PATERNAL GRANDPARENTS ______________________________________

______________________________________

MATERNALGRANDPARENTS ______________________________________
______________________________________
PLACE and DATE REGISTERED: ____________________________________
____________________________________
Volume, Page and Number:
____________________________________
Name of Judge (if delayed registration): ______________________________
WITNESSES: _____________________ & ____________________________
DATE & PLACE THIS COPY ISSUED: ________________________________
I, ______________________________, attest to my competency to translate from
___________________________ to English, and I certify that this is a correct English
translation of all pertinent information from the _______________________ original.
____________________________________

Date: _______________________