Translation of birth certificate, USSR

BIRTH CERTIFICATE

The citizen —-

was born on — (—).

Place of birth:

Town —,

Region ——-

Oblast —,

Republic Ukrainian Soviet Socialistic Republic

That was registered in the civilian registry book

From —.

Record # —

1

Father: —

nationality: Ukrainian

Mother: —-

Nationality: Ukrainian

Place of registration: regional department of civilian registry office in — oblast, USSR

Date of issue: —-, 1985

Round official seal

Registry office of

—– oblast

Registration department

Signature of the Head of the Department of civilian registry office: signature

— № —-

2