UKRAINE

BIRTH CERTIFICATE

Surname Matsiutsia
Name David patronymic name Hennadiyovych
was born September 13. 2006.
On the thirtieth of September, two thousand and six
(year, month and date of birth in words and numbers)
Birth place: UKRAINE
Luhansk
city, town (village)

about what was written in the register of births in the year 2006 in September, on the 22
and made the reasonable note at the number 675

Father Matsiutsia
surname
Hennadii Viktorovych
name, patronymic name
citizen UKRAINE
Mother Matsiutsia
surname
Liudmyla Vasylivna
name, patronymic name
citizen UKRAINE
Place of registration Department of Registration of Civil Status Acts of Lysychansk City
Department of Justice, Luhansk Region, Ukraine

Name and registered address of authority which issued the birth certificate Department of Registration of
Civil Status Acts of Lysychansk City Department of Justice

Date of issue 22.09.2006

Place of the seal /signed/

Head of the state body for registration of civil status acts/ Rodkina V.M.
/Seal: Ministry of Justice of Ukraine Department of Registration of Civil Status Acts of Lysychansk
City Department of Justice, Luhansk Region/

Series I-ED № 052980