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(Translation)

Thor.Ror.14/2

Official Emblem
Certified Civil Registration Data base
Date : . Registration Office :

Name : ..
Identification No : Date of Birth :
...
Sex : ... Nationality : Status :
...
Name of natural mother : Nationality :

Name of natural father : . Nationality :


..

Address :
.

House Code No : ... Date of living in


:

Addendum

Certified Correct Civil Registration Data


base
Registrar

Certified correct
translation
Signed .
(

)
Translator