Birth Certificate
-----(Surname)
-----(Name, patronymic)
Born ------------------(Date, month year)
--------------------------(Date, month and year in figures and writing)
Place of birth: city, settlement
------district -----region, area -----republic -----Entered in the register of births on ----date __ month __ year __
as entry No. ---Parents:
Father ----(Surname)
----- ---------(Name, patronymic)
nationality -----Mother ------(Surname)
----- ------(Name, patronymic)
nationality -------Place of official registration: -------------Issuing authority: ---------Date of issue ----- ------ ----Chief registrar (signature)