Translation of certificate about change of name

 

CHANGE of NAME CERTIFICATE

 

Last name —

First name —

Patronymic name —

Date of birth —

Place of birth — oblast, Ukraine

 

Changed her name into —-

 

That was registered in the

Change of Name Registry Book — # —

 

Place of registration Department of civilian registry office in town of —, — oblast

State authority that issued

the certificate Department of civilian registry office in town of —, — oblast

 

Date of issue —

 

 

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

Round official seal

Department of civilian registry office in town of —, — oblast

Series —№ —