EXTRACT TRANSLATION STAMP
CLAIM NO. _________________________________________
THIS IS A B/C ___ BAPT/C ____ D/C ____ M/C _____ OTHER ______
DOCUMENT RELATES TO:
BIC ______ NAME ____________ SSN:_____________ AGE ___________
(IF MARRIAGE CERTIFICATE) SPOUSE'S NAME: ___________________ AGE ________
(IF POA) FATHER: ________________________ MOTHER: ____________________________
DATE OF EVENT/BIRTH ______________________________
PLACE OF EVENT/BIRTH __________________________________________
NAME OF OFFICIATING PRIEST (IF MEXICAN BAPTISMAL CERTIFICATE)
_______________________________________________________________________
DATE OF RECORDATION _______________________________
ISSUING AGENCY ________________________________________________
DATE ISSUED ________________________________________________
THE ORIGINAL, OF WHICH THIS IS A PHOTOCOPY, APPEARS TO BE GENUINE, UNALTERED, AND
TO HAVE BEEN MADE AT THE TIME PURPORTED.
TRANSLATOR'S SIGNATURE: ________________________________ TITLE _________
DATE DOCUMENT TRANSLATED _____________________________________