BASED ON ARTICLE 11 SECTION XI AND 15 OF THE ORGANIC LAW OF THE CIVIL REGISTRY OF THE STATE OF BAJA

CALIFORNIA, IN RELATION TO ARTICLES 2, SECTION III, INTERJECTION (D)) AND 37, SECTION II AND IV OF THE
INTERNAL REGULATION OF THE GENERAL SECRETARIAT OF GOVERNMENT, AND IN EXERCISE OF THE POWERS THAT
WERE DELEGATED TO ME BY MEANS OF AGREEMENT ISSUED BY THE SECRETARY GENERAL OF GOVERNMENT, I
AFFIRM THAT THIS FILE BEFORE YOU, THAT IT IS FILED AND RECORDED AS THE ONE PRESENT.

UNITED STATES
OF MEXICO LOGO

XXX

UNITED STATES OF MEXICO

GOVERNMENT OF THE FREE AND SOVEREIGN STATE

OF BAJA CALIFORNIA

CIVIL REGISTRATION
BIRTH CERTIFICATE
OFFICE NO.

YEAR

xxxx

CERTIFICATE #

CITY / MUNICIPALITY:

xxxx

BOOK NO.

MEXICALI

NAME:
DATE OF BIRTH:
REGISTERED
PLACE OF BIRTH:

VOLUME

xx

PAGE:

OFFICE LOCATION:

xxx

STATE:

BAJA CALIFORNIA

REGISTRANT'S INFORMATION
ALIVE

CERTIFICATE NUMBER
x
BAJA CALIFORNIA
------------------

CITY
STATE
CURP

PARENTS' INFORMATION
FATHERS NAME
HOME ADDRESS
CITY
STATE
DATE OF BIRTH:
NATIONALITY
MOTHERS NAME
HOME ADDRESS
CITY
STATE
DATE OF BIRTH:
NATIONALITY

DD/M

SEX:
PRESENT AT BIRTH:

xxxxxxxxx
COUNTY
COUNTRY
CRIP

DATE OF

x
MEXICO
xxxxxx

Registration and Personal Identity Code

AGE
COUNTY
COUNTRY
BIRTH PLACE
CERTIFIED -----------------AGE

MEXICAN

COUNTY
COUNTRY
BIRTH PLACE
CERTIFIED ------------------

MEXICAN

GRANDPARENTS' INFORMATION

PATERNAL GRANDFATHER
HOME ADDRESS
PATERNAL GRANDMOTHER
HOME ADDRESS
MATERNAL GRANDFATHER
HOME ADDRESS
MATERNAL GRANDMOTHER
HOME ADDRESS

WITNESS INFORMATION
NAME
HOME ADDRESS
NAME
HOME ADDRESS

NATIONALITY

ME

NATIONALITY

ME

NATIONALITY

ME

NATIONALITY

ME

NATIONALITY
AGE
NATIONALITY
AGE

ME

ME

UNRELATED PERSON PRESENTING THE REGISTRANT

NAME
----------------------RELATIONSHIP
--------HOME ADDRESS
----------------------AGE
-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

SIGNATURES

FATHER OR UNRELATED PERSON PRESENTING THE REGISTANT

SIGNATURE
TYPE NAME HERE
WITNESS
SIGNATURE
TYPE NAME HERE

MOTHER
SIGNATURE
TYPE NAME HERE
WITNESS
SIGNATURE
TYPE NAME HERE

READ THIS ACT AND IN ACCORDANCE WITH ITS CONTENTS, ITS CONFIRMED AND SIGNED BY THOSE WHO PARTICIPATE AND UNDERSTAND THOSE WHO DONT SHALL BY FINGERPRINT. I H
TERMS OF ARTICLE 68 OF THE ORGANIC LAW OF THE CIVIL REGISTRATION OF THE STATE OF BAJA CALIFORNIA.

OFFICIAL 3 OF THE CIVIL REGISTRY

SIGNATURE

NAME HERE
SIGNATURE

NAME HERE

REGIST
FINGER

CIVIL REGISTRY LOGO

XXXXXX
ARCHIVE

PRINTED: MEXICALI, BAJA CALIFORNIA, XX/XX

CIVIL REGISTRY DEPUTY DIRECTOR

XXXXXXX

I, _____________________, certify that I am fluent (conversant) in the English and Spanish language
and that the attached document is an accurate translation of the document entitled Birth
Certificate of XXXX XXXXX XXXXXX

SIGNED: ________________________

NAME: _________________________
ADDRESS: _______________________
TELEPHONE: ____________________
DATE: __________________________
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CIVIL
REGISTRY
LOGO

REGISTRATION
H CERTIFICATE
OFFICE LOCATION:
DATE OF REGISTRATION

DD/MM/YYYY

ANT'S INFORMATION

x
BOTH PARENTS
x
MEXICO
xxxxxx

NTS' INFORMATION

Registration and Personal Identity Code

------------------

------------------

RENTS' INFORMATION

MEXICAN
MEXICAN
MEXICAN
MEXICAN

ESS INFORMATION

MEXICAN
MEXICAN

N PRESENTING THE REGISTRANT

---------------------------------------------

-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

SIGNATURES

MOTHER
SIGNATURE
TYPE NAME HERE
WITNESS
SIGNATURE
TYPE NAME HERE

THOSE WHO PARTICIPATE AND UNDERSTAND THOSE WHO DONT SHALL BY FINGERPRINT. I HAVE FAITH IN THE
AJA CALIFORNIA.

REGISTERED
FINGERPRINT

PRINTED: MEXICALI, BAJA CALIFORNIA, XX/XX/XXXX

XXXXXXX

t (conversant) in the English and Spanish languages

te translation of the document entitled Birth