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STAMP

Ukraine

Town council of —-

— utility enterprise “Vodokanal”

—town of —, — oblast

# —-, —

 

CERTIFICATE # —

Town of —

Issued to —

Born on —-

to certify that she is really resident of —.

 

 

The family consists of:

Son – —- – born on —-.

 

The certificate is issued at demand.

 

SEAL

FOR CERTIFICATES

Town council of —

— utility enterprise “Vodokanal”

—— oblast

 

 

Registrar of

—- utility enterprise

“Vodokanal” Signature —-