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.XXX X 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.

Registrant’s Information
Name: FIRST MIDDLE PATERNAL MATERNAL
Time:XX:XX
Date of Birth: Month X, 19XX
Present at Birth: Both Parents
Born:Alive
Sex:Male

C
ertificate 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: Dad’sFIRST MIDDLE PATERNAL MATERNAL
Age:XX
Nationality:Mexican
Name: Mom’sFIRST MIDDLE PATERNAL MATERNAL
Age:XX
Nationality:Mexican
Grandparents’ Information
Name: Grandpa’sFIRST MIDDLE PATERNAL MATERNAL
Nationality:Mexican
Name: Grandma’sFIRST MIDDLE PATERNAL MATERNAL
Nationality:Mexican
Name: Grandpa’sFIRST MIDDLE PATERNAL MATERNAL
Nationality:Mexican
Name: Grandma’sFIRST MIDDLE PATERNAL MATERNAL
Nationality:Mexican
Witness’ Information
Name: FIRST MIDDLE PATERNAL MATERNAL
Age:XX
Nationality:Mexican
Name: FIRST MIDDLE PATERNAL MATERNAL
Age:XX
Nationality:Mexican
Unrelated Person Presenting the Registrant
Name:N/A
Age:N/A
Nationality: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 Nuevo
Leon on the 6th 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

Certification by Translator:

I (typed name) , certify that I am fluent (conversant) in the English and (type the foreign language)
languages, and that the above/attached document is an accurate translation of the document attached
entitled (name of document).

Signature ______________________ Typed Name _________________

Date ___________ Address _____________________