United States of Mexico

Civil Registry
Birth Certificate
In the name of the free and sovereign state of Nuevo Leon, and as Director-General of the
Civil Registry of the State, I certify that in Book No. XX Volume 1 of the General Archive of
the Civil Registry on page No. XXXX, a record reading No. XXXX can be found containing the
information that follows, dated (Month) XX, 19XX, brought forth by Civil Registry Clerk XX,
Jesus Navarro Tejada, resident of Monterrey, Nuevo Leon, United States of Mexico.
Registrants Information
Name: FIRST MIDDLE PATERNAL MATERNAL
Time: XX:XX
Date of Birth: Month X, 19XX
Present at Birth:
Both Parents
Born: Alive
Sex: Male
Certificate
Number:
XXXXX
Place of Birth: Monterrey, Nuevo Leon, United States of Mexico
Registration and Personal Identity Code (CRIP): XX-XXX-XX-XXXXXXX-X
Individual Identification Number (CURP): LLLLXXXXXXLLLLLLXX
Parents Information
Name: Dads FIRST MIDDLE PATERNAL MATERNAL
Nationality: Mexican

Age: XX

Name: Moms FIRST MIDDLE PATERNAL MATERNAL

Nationality: Mexican
Grandparents Information
Name: Grandpas FIRST MIDDLE PATERNAL MATERNAL
Mexican
Name: Grandmas FIRST MIDDLE PATERNAL MATERNAL
Mexican
Name: Grandpas FIRST MIDDLE PATERNAL MATERNAL
Mexican
Name: Grandmas FIRST MIDDLE PATERNAL MATERNAL
Mexican
Witness Information
Name: FIRST MIDDLE PATERNAL MATERNAL
Nationality: Mexican
Name: FIRST MIDDLE PATERNAL MATERNAL
Nationality: Mexican
Name: N/A
Nationality: N/A

Age: XX

Nationality:
Nationality:
Nationality:
Nationality:

Age: XX
Age: XX

Unrelated Person Presenting the Registrant

Age: N/A

Payment Information: Monterrey, NL to Directorate, February 6, 2007

Prepared by: Genoveva Briones
Birth Certificates
Total: $29

(****TWENTY-NINE and 00/100 MEXICAN PESOS****)

This Certification has been issued in compliance with Article 46 of the current State Civil
Code in the city of Monterrey, Capital of the state of NuevoLeon on the 6 th day of the month
of February, 2007. I hereby attest.
By the executive power of the State, this document is signed by the Chief of Control and
Statistics of the Directorate of the Civil Registry, C.P. Jose Jaime Delgado Aleman.
Director of the Civil Registry
Benjamin Mario Mendoza Garza

I, LOSGUERRA, certify that I am fluent in the Spanish and English languages and hereby
certify that the above information is a true, complete and accurate translation of the
attached original document entitled Acta de Nacimiento

.July 30, 2008

My Name
My street address
City, ST ZIP