TRANSLATION OF FOREIGN BIRTH CERTIFICATE

ISSUING NATION ISSUING STATE ISSUING CITY / MUNICIPALITY

DATE OF REGISTRATION CERTIFICATE NUMBER ID / REGISTRATION CODE

= = = = = = = REGISTERED CHILD = = = = = = =

FIRST NAME MIDDLE NAME SURNAME (S)

DATE OF BIRTH PLACE OF BIRTH SEX

= = = = = = = CHILD’S PARENTS = = = = = = =

FATHER: FIRST NAME MIDDLE NAME SURNAME (S)

MOTHER: FIRST NAME MIDDLE NAME SURNAME (S)

= = = = = = = CIVIL REGISTRY OFFICIAL = = = = = = =

TITLE FIRST NAME SURNAME(S)

CERTIFICATION OF TRANSLATOR

I, TRANSLATOR’S NAME, declare under penalty of perjury that I understand the Spanish
language and the English language; and that, to the best of my knowledge and belief, the
statements in the English language in the attached translation have the same meaning as the
statements in the Spanish language in the document that I have examined.

________________
Signature of Translator Date