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