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Translation
from Russian into English
SURNAME, FIRST NAME, PATRONYMIC
CHANGE CERTIFICATE
Citizen Ivanov
Ivan Ivanovich
surname, first name, patronymic
borne on the
1st of January 1960
Place
of birth Moscow
has changed his (her) surname, first
name, patronymic to
Petrov
Petr Petrovich
surname, first name, patronymic
in
witness whereof an entry
under number 11111
was made
in
the Surname, First Name,
Patronymic Change Register
on the
1st
(day) of December
(month) 1992
Place
of registration: Branch
of Civil Status Registration Office
name
and location
of
the Yuzhny District of the city of
Moscow
of
Civil Status Registration Office Branch
Date
of issue: the 20th of
January, 1992
Seal
here Head
of the branch of the Civil Status
Registration Office
(signature)
|
Seal: |
Branch
of Civil Status Registration
Office |
of
the Yuzhny district of the city
of Moscow |
Certificate number I-AA
№ 444333 |
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