Ukraine
State Emblem
MARRIAGE CERTIFICATE
Family name —
Name —
Patronymic name —
Born —
in — town, — oblast, Ukraine
Citizen of Ukraine
Family name —
Name —
Patronymic name —
Born on —
in — town, — region, — oblast, Ukraine
Citizen of Ukraine
have entered into a marriage —- (the —-)
that is registered in the civilian registry book record No.— from —.
After marriage the husband has received the family name —, wife: —.
Place of registration: registry office of —- regional Administrationof Justice .
State authority that issued the certificate: registry office of — regional Administrationof Justice in —.
Data of issue: —
Signature of the head of the
registry office: signature /—/
Round official seal
Ministry of Justice of Ukraine
registry office of —- regional Administration of Justice in — oblast.
Series: — #–