Download as docx, pdf, or txt
Download as docx, pdf, or txt
You are on page 1of 2

FRATERNITY EQUALITY FREEDOM

REPUBLIC OF HAITI

IN THE NAME OF THE REPUBLIC

Extract from the minutes of the Registry of the Peace Court of the South Section of Port-au-Prince

IN THE NAME OF THE REPUBLIC

Today, the third day of the month of April two thousand and twenty-three, Year 220 of Us, Me. Philippe
VINCENT, Justice of the Peace of the South Section of Port-au-Prince, Officer Independence at ten
o'clock in the morning. of the Judicial Police, Auxiliary of the Government Commissioner at the Court of
First Instance of Port-au-Prince, assisted by the citizen Jean Smith GELIN, our Registrar.

Had compared:

Mrs Rose Nadine VICTOR, identified at No: 005-270-208-6, owner, residing and domiciled at Mahothiere
75, Carrefour, biological mother of the minor child Withney Kenberly FENELON, identified by her
passport at No: GV5637632, born at Port-au-Prince, September 10, two thousand and sixteen
(September 10, 2016), resulting from his natural works with Mr. Ken Getro FENELON, identified at No,
26.027.074-5, currently residing and domiciled in Tulipanes at # 2114, Municipality of Renca,
Metropolitan Region, Chile

Which appearing party, jointly with Mr. Ken Getro FENELON, authorize Mr. Fabrice Yvan ST LOUIS,
identified with the numbers of his passport R11724443 and his national identification card: 1110449890,
traveled to the United States of America with their minor daughter Withney Kenberly FENELON to give
her to Mr. Pierre Milot MOROSE at the following address: 4897 Raleigh ST Apt. 3, Orlando Florida, to
feed her, house her, clothe her and perfect her education Required to sign, she did Mrs. Rose Nadine
VICTOR. We Justice of the Peace, aforesaid and undersigned; Having regard to the foregoing statements
and the reasons contained therein; Having regard to the exhibits submitted; Given the law does not
prevent Given the laws and provisions of laws governing the matter.

Have acknowledged the appearing party's statements and declarations. In witness whereof, this present
AUTHORIZATION is issued to serve and assert what is right, we signed it on the day, month, year and
hour above with the appearing parties and our clerk, after reading.

Thus signed at the minute: Me. Philippe VINCENT, Justice of the Peace and Jean Smith GELIN,

Clerk. FOR COMPLIANT SHIPPING

COLLATED Jean Smith GELIN Registrar

Seen by us lege de ex of the South Section of Port-au-Prince for the legalization of the signature of the
reflect he Philippe V CENT Judge of charge.

Anyone who has fad a private use of this form will be liable to a fine of cant gourdes (Law of August 6,
1915)

You might also like