|
O‘zbekiston Respublikasi | |
|
| |
|
Fuqaro _________________________________________________________________________ | |
|
(familiyasi) | |
|
________________________________________________________________________________ | |
|
(ismi, otasining ismi) | |
|
va fuqaro _______________________________________________________________________ | |
|
(familiyaci) | |
|
________________________________________________________________________________ | |
|
(ismi, otasining ismi) | |
| nikohdan ajralishdi, bu haqda ____ yil____ oyining____ kunida___ -son bilan dalolatnoma yozuvi qayd etildi. Nikohdan ajralgandan keyin quyidagi familiyalar berildi: | |
|
erga ___________________________________________________________________________ | |
|
xotinga _________________________________________________________________________ | |
|
Qayd etish joyi __________________________________________________________________ | |
|
(FHDYo organining nomi) | |
|
Guvohnoma fuqaro ________________________________________________________________ | |
|
(familiyasi) | |
|
_______________________________________________________________________ ga berildi. | |
|
(ismi, otasining ismi) | |
|
Berilgan vaqti ____________ yil “ ______ ” __________________________________________ | |
|
Fuqarolik holati dalolatnomalarini | |
| | |
| Muhr | |
|
I—O'z № 0000000 | |
| | |
|
(1-ilovaning davomi) | |
|
| |
|
Grajdanin ______________________________________________________________________ | |
|
(familiya) | |
|
________________________________________________________________________________ | |
|
(imya, otchestvo) | |
|
i grajdanka _____________________________________________________________________ | |
|
(familiya) | |
|
________________________________________________________________________________ | |
|
(imya, otchestvo) | |
|
rastorgli brak, o chem _________________ chisla ____________ mesyatsa ________________ goda | |
| Proizvedena aktovaya zapis za № ___________________. | |
| Posle rastorjeniye braka prisvoyeni familii: | |
|
muju ___________________________________________________________________________ | |
|
jene ___________________________________________________________________________ | |
|
Mesto registratsii _______________________________________________________________ | |
|
(naimenovaniye organa ZAGsa) | |
|
________________________________________________________________________________ | |
|
Sviditelstvo vidano grajdaninu (ke) ______________________________________________ | |
|
(familiya) | |
|
_________________________________________________________________________________ | |
|
(imya, otchestvo) | |
|
Data vidachi “ _______ ” ________________________________________________________ goda | |
| Zaveduyuщiy(aya) organom zapisi aktov grajdanskogo sostoyaniya _______________________ | |
| | |
| Pechat | |
|
I—O'z № 0000000 | |
| | |
|
(1-ilovaning davomi) | |
|
DIVORCE CERTIFICATE | |
|
The marriage of _____________________________________________________________________ | |
|
(surname) | |
| __________________________________________________________________________________ | |
|
(given names) | |
| and ______________________________________________________________________________ | |
|
(surname) | |
| _________________________________________________________________________________ | |
|
(given names) | |
| is dissolved, record of divorce No. ___ was failed on ________ of the year _______________________. | |
| Upon dissolution of marriage the following surnames were given to husband ______________________ | |
| wife _____________________________________________________________________________ | |
| Place of registration _________________________________________________________________ | |
|
(name and location of the Registry office) | |
| ________________________________________________________________________________ | |
| The present Certificate is issued to ______________________________________________________ | |
|
(surname) | |
| ________________________________________________________________________________ | |
|
(given names) | |
| Date of issue ______________________________________________________________________ | |
|
(day, month, year) | |
| Registrar _______________ | |
| | |
| Seal | |
|
I—O'z № 0000000 | |
|
O‘zbekiston Respublikasi | |
|
NIKOHDAN AJRALGANLIK HAQIDA GUVOHNOMA | |
|
| |
|
Puxara |
(familiyasi,/ familiyasi) |
|
____________________________________________________________________________ | |
|
(ismi, otasining ismi /ati, ekesinin ati) | |
|
va fuqaro ___________________________________________________________________ | |
|
hem puxara |
(familiyasi / familiyasi) |
|
____________________________________________________________________________ | |
|
(ismi, otasining ismi /ati, ekesinin ati) | |
|
nikohdan ajralishdi, bu haqda _______ yil__________ oyining________ kunida ________ - son bilan dalolatnoma yozuvi qayd etildi. | |
|
erga_________________________________________________________________________ | |
|
xotinga ______________________________________________________________________ | |
|
Qayd etish joyi_______________________________________________________________ | |
|
(FHDYo organining nomi/PXAJ organiniң ati) | |
| | |
|
Guvohnoma fuqaro ____________________________________________________________ | |
|
(familiyasi,/ familiyasi) | |
|
__________________________________________________________________ ga berildi. | |
|
(ismi, otasining ismi /ati, ekesinin ati) | |
| Berilgan vaqti __________ yil “ _______ ” ____________________ Berilgen o‘aqti __________ jil “ _______ ” ___________________ | |
| Fuqarolik holati dalolatnomalarini yozish organi mudiri ______________________ Puxaraliq halati aktlerin jazio‘ organi baslig‘i _____________________________ | |
Muhr Mor |
|
|
I—QQ № 0000000 | |
| | |
|
(2-ilovaning davomi) | |
|
SVIDETELSTVO O RASTORJENII BRAKA | |
|
Grajdanin ___________________________________________________________________ | |
|
(familiya) | |
|
____________________________________________________________________________ | |
|
(imya, otchestvo) | |
|
i grajdanka__________________________________________________________________ | |
|
(familiya) | |
|
____________________________________________________________________________ | |
|
(imya, otchestvo) | |
|
rastorgli brak, o chem __________ chisla _________ mesyatsa _____________ goda | |
|
Proizvedena aktovaya zapis za № ____________. | |
|
Posle rastorjeniye braka prisvoyeni familii: | |
|
muju_______________________________________________________________________ | |
|
jene________________________________________________________________________ | |
|
Mesto registratsii____________________________________________________________ | |
|
(naimenovaniye organa ZAGsa) | |
|
____________________________________________________________________________ | |
|
Sviditelstvo vidano grajdaninu (ke) ____________________________________________ | |
|
(familiya) | |
|
____________________________________________________________________________ | |
|
Data vidachi “ _____ ” ___________________ goda | |
|
| |
Pechat |
|
|
| |
|
|
|
(2-ilovaning davomi) | |
|
DIVORCE CERTIFICATE | |
|
The marriage of ________________________________________________________________ | |
|
(surname) | |
|
____________________________________________________________________________ | |
|
(given names) | |
|
and _________________________________________________________________________ | |
|
(surname) | |
|
____________________________________________________________________________ | |
|
(given names) | |
|
is dissolved, record of divorce No. ____ was failed on ______ of the year _________. | |
|
Upon dissolution of marriage the following surnames were given to | |
|
wife _________________________________________________________________________ | |
|
Place of registration _____________________________________________________________ | |
|
(name and location of the Registry office) | |
|
_____________________________________________________________________________ | |
|
The present Certificate is issued to__________________________________________________ | |
|
(surname) | |
|
____________________________________________________________________________ | |
|
(given names) | |
|
Date of issue__________________________________________________________________ | |
|
(day, month, year) | |
| |
|
Seal |
|
|
| |
| | |
30-iyundagi 330-son qaroriga
1-ILOVA
(Vazirlar Mahkamasining 2003-yil
5-iyundagi 249-son qarori tahririda)
|
O‘zbekiston Respublikasi |
|
|
TUG‘ILGANLIK HAQIDA GUVOHNOMA |
|
|
Fuqaro______________________________ |
Otasi ______________________________ |
|
(familiyasi) |
(familiyasi) |
|
____________________________________ |
____________________________________ |
|
(ismi, otasining ismi) |
(ismi, otasining ismi) |
|
______yil________ oyining_____ kunida |
millati _____________________________ |
|
____________________________________ |
Onasi ______________________________ |
| |
(familiyasi) |
|
______________________________tug‘ildi |
____________________________________ |
|
(raqam va so‘z bilan) |
(ismi, otasining ismi) |
|
Tug‘ilgan joyi: ____________Respublikasi |
millati _____________________________ |
|
______________________________viloyati |
Qayd etish joyi_______________________ |
| |
(FHDYo organining nomi) |
|
______________________________tumani |
____________________________________ |
|
_______________shahri, shaharchasi, qishlog‘i |
Berilgan vaqti____yil “___” ____________ |
|
Bu haqda ___yil ______oyining____ kunida |
|
|
__- son bilan dalolatnoma yozuvi qayd etildi. |
Fuqarolik holati dalolatnomalarini |
| | Muhr |
| |
|
|
(1-ilovaning davomi) |
|
|
SVIDETELSTVO O ROJDENII |
|
|
Grajdanin (ka) ______________________ |
Otets_______________________________ |
|
(familiya) |
(familiya) |
|
____________________________________ |
____________________________________ |
|
(imya, otchestvo) |
(imya, otchestvo) |
|
rodilsya (las) “____” _____________ goda |
Mat_______________________________ |
| |
(familiya) |
|
____________________________________ |
____________________________________ |
| |
(imya, otchestvo) |
|
____________________________________ |
natsionalnost _____________________ |
|
(tsiframi i propisyu) |
|
|
Mesto rojdeniya: Respublika ___________ |
Mesto registratsii ___________________ |
| |
(naimenovaniye organa ZAGSa) |
|
_____________________________ oblast |
____________________________________ |
|
______________________________rayon |
Data vidachi “ ____ ” _____________ goda |
|
gorod, posyolok, kishlak _______________ |
|
|
Ob etom “ ______ ” _______________ goda |
Zaveduщiy (aya) organom zapisi |
|
proizvedena aktovaya zapis za № _______ |
Pechat |
| |
|
| | |
|
(1-ilovaning davomi) |
|
|
|
|
|
Citizen ______________________________ |
Father _______________________________ |
|
(surname) |
(surname) |
|
____________________________________ |
____________________________________ |
|
(given names) |
(given names) |
|
was born on __________________________ |
nationality (etnic) _______________________ |
|
(day, month, year in figures and words) |
|
|
____________________________________ |
Mother ______________________________ |
| |
(surname) |
|
____________________________________ |
____________________________________ |
| |
(given names) |
|
Place of birth: Republic __________________ |
nationality (etnic) ______________________ |
|
_______________________________region |
Place of registration _____________________ |
| |
(name and location of the Registry Office) |
|
______________________________district |
____________________________________ |
|
___________________________city, village. |
Date of issue “ ___ ” ___________________ |
|
Birth record No. ____ was filed on _________ |
Registrar _______________________ |
|
(day, month, year) |
|
|
|
Seal |
|
|
|
30-iyundagi 330-son qaroriga
1a-ILOVA
(Vazirlar Mahkamasining 2003-yil
5-iyundagi 249-son qarori tahririda)
|
O‘zbekiston Respublikasi |
|
|
TUG‘ILGANLIK HAQIDA GUVOHNOMA |
|
|
Fuqaro __________________________________ |
Otasi __________________________________ |
| Puxara (familiyasi/familiyasi) | Ekesi (familiyasi/familiyasi) |
|
____________________________________________ |
_______________________________________ |
|
(ismi, otasining ismi/ati, Ekesiniң ati) |
(ismi, otasining ismi/ati, Ekesiniң ati) |
|
_________yil __________ oyining ________ kunida |
millati _______________________________ |
|
____________________________________ |
Onasi _________________________________ |
| |
(familiyasi/familiyasi) |
|
____________________________________ tug‘ildi |
_______________________________________ |
|
(ismi, otasining ismi/ati, Ekesiniң ati) |
|
Tug‘ilgan joyi: ___________________Respublikasi |
millati ________________________________ |
|
____________________viloyati |
Qayd etish joyi __________________________ |
|
oblasti |
Dizimge aling‘an jeri (FHDYo organining nomi) |
| |
________________________________________ |
| |
(FHDYo organining nomi/PXAJ organiniң ati) |
|
____________tumani |
_________________________________________ |
|
____________ shahri, shaharchasi, qishlog‘i |
Berilgan vaqti____yil “____” _______________ |
|
Bu haqda ___yil ______oyining__ kunida |
|
|
___son bilan dalolatnoma yozuvi qayd etildi. |
Fuqarolik holati dalolatnomalarini |
| Puxaraliq halati aktlerin jazio‘ organi baslig‘i _______ | |
| | Muhr Mor |
| |
|
|
(1-ilovaning davomi) |
|
|
SVIDETELSTVO O ROJDENII |
|
|
Grajdanin (ka) ______________________ |
Otets_______________________________ |
|
(familiya) |
(familiya) |
|
____________________________________ |
____________________________________ |
|
(imya, otchestvo) |
(imya, otchestvo) |
|
rodilsya (las) “____” _____________ goda |
Mat_______________________________ |
| |
(familiya) |
|
____________________________________ |
____________________________________ |
| |
(imya, otchestvo) |
|
____________________________________ |
natsionalnost _____________________ |
|
(tsiframi i propisyu) |
|
|
Mesto rojdeniya: Respublika ___________ |
Mesto registratsii ___________________ |
| |
(naimenovaniye organa ZAGSa) |
|
_____________________________ oblast |
_____________________________________________ |
|
______________________________rayon |
Data vidachi “ ____ ” _____________ goda |
|
gorod, posyolok, kishlak _______________ |
|
|
Ob etom “ ______ ” _______________ goda |
Zaveduщiy (aya) organom zapisi |
|
proizvedena aktovaya zapis za № _______ |
Pechat |
| |
|
| | |
|
(1a-ilovaning davomi) |
|
|
|
|
|
Citizen ______________________________ |
Father ______________________________ |
|
(surname) |
(surname) |
|
___________________________________ |
____________________________________ |
|
(given names) |
(given names) |
|
was born on __________________________ |
nationality (etnic) ______________________ |
|
____________________________________ |
Mother _____________________________ |
| |
(surname) |
|
____________________________________ |
____________________________________ |
| |
(given names) |
|
Place of birth: Republic _________________ |
nationality (etnic) ______________________ |
|
_______________________________region |
Place of registration ____________________ |
| |
(name and location of the Registry Office) |
|
______________________________district |
____________________________________ |
|
___________________________city, village. |
Date of issue “ ____ ” __________________ |
|
|
|
|
(day, month, year) |
|
|
|
Seal |
|
|
|
1997-yil 30-iyundagi 330-son qaroriga
2-ILOVA
(Vazirlar Mahkamasining 2003yil 5-iyundagi
249-son qarori tahririda)
|
O‘zbekiston Respublikasi |
|
|
NIKOH TUZILGANLIGI HAQIDA GUVOHNOMA |
|
|
Fuqaro_____________________________________ |
Bu haqda______yil_______oyining______kunida |
|
__________________________________________ |
_______-son bilan dalolatnoma yozuvi qayd etildi. |
|
tug‘ilgan vaqti______yil “ _______ ”___________ |
Nikoh qayd etilgandan keyin quyidagi familiyalar berildi: |
|
tug‘ilgan joyi _______________________________ |
eriga ________________________________________ |
|
____________________________________________ |
xotiniga _____________________________________ |
|
va fuqaro____________________________________ |
Qayd etish joyi _____________________________ |
|
____________________________________________ |
_____________________________________________ |
|
Tug‘ilgan vaqti_____yil “_______”______________ |
Berilgan vaqti____ yil “ _______ ”_____________ |
|
tug‘ilgan joyi ________________________________ |
|
|
_____________________________________________ |
Fuqarolik holati dalolatnomalarini yozish organi mudiri _____________________ |
|
_____yil________________oyining________kunida |
|
|
_____________________________________________ |
Muhr |
|
________________________________nikoxlandilar. |
|
| |
|
|
(2-ilovaning davomi) |
|
|
SVIDETELSTVO O ZAKLYuChENII BRAKA |
|
|
Grajdanin__________________________________ |
Ob etom “ ____ ” __________________________ goda |
|
_____________________________________________ |
proizvedena aktovaya zapis za № _______________. |
|
data rojdeniya “____” _____________________ goda |
Posle registratsii braka prisvoyeni familii: |
|
mesto rojdeniya _______________________________ |
muju ________________________________________ |
|
_____________________________________________ |
jene ________________________________________ |
|
i grajdanka __________________________________ |
Mesto registratsii ____________________________ |
|
_____________________________________________ |
_____________________________________________ |
|
data rojdeniya “____” _____________________ goda |
data vidachi “_____” _____________________ goda |
|
mesto rojdeniya _______________________________ |
|
|
_____________________________________________ |
Zaveduщiy (aya) organom zapisi aktov grajdanskogo sostoyaniya _______________ |
|
zaklyuchili brak “ _____ ” __________________ goda |
Pechat |
|
_____________________________________________ _____________________________________________ |
|
| | |
|
(2-ilovaning davomi) |
|
|
|
|
|
_____________________________________________ |
Marriage record No. _____ was filed on _____________ |
|
_____________________________________________ |
In the marriage the following surnames were given to |
|
date of birth ___________________________________ |
husband ______________________________________ |
|
place of birth___________________________________ |
wife__________________________________________ |
|
_____________________________________________ |
Place of registration _____________________________ |
|
and __________________________________________ |
_____________________________________________ |
|
_____________________________________________ |
Date of issue “ ____ ” ___________________________ |
|
date of birth ___________________________________ |
|
|
place of birth___________________________________ |
Registrar _________________________ |
|
_____________________________________________ |
|
|
married on ____________________________________ |
Seal |
|
_____________________________________________ |
|
|
|
|
|
|
|
30-iyundagi 330-son qaroriga
2a-ILOVA
(Vazirlar Mahkamasining 2003-yil
5-iyundagi 249-son qarori tahririda)
|
O‘zbekiston Respublikasi |
|
|
NIKOH TUZILGANLIGI HAQIDA GUVOHNOMA |
|
|
Fuqaro Puxara ______________________________ |
Bu haqda______yil_________oyining______kunida |
|
____________________________________________ |
_______-son bilan dalolatnoma yozuvi qayd etildi. |
|
tug‘ilgan vaqti______yil “ ____ ”______________ |
Nikoh qayd etilgandan keyin quyidagi familiyalar berildi: |
|
tug‘ilgan joyi ________________________________ |
eriga yerine__________________________________ |
|
_____________________________________________ |
xotiniga hayalina______________________________ |
|
va fuqaro hem puxara___________________________ |
Qayd etish joyi Dizimge aling‘an jeri__________ |
|
_____________________________________________ |
_____________________________________________ |
|
Tug‘ilgan vaqti_____yil “_______”______________ |
Berilgan vaqti____ yil “ _______ ”_____________ |
|
tug‘ilgan joyi ________________________________ |
|
|
_____________________________________________ |
Fuqarolik holati dalolatnomalarini yozish organi mudiri _____________________ Puxaraliq halati aktlerin jazio‘ organi baslig‘i __________________ |
|
_____yil________________oyining________kunida |
|
|
____________________________________________ |
Muhr |
|
_____________________nikohlandilar. nekelesti. |
|
| |
|
|
(2a-ilovaning davomi) |
|
|
SVIDETELSTVO O ZAKLYuChENII BRAKA |
|
|
Grajdanin__________________________________ |
Ob etom “ ____ ” __________________________ goda |
|
_____________________________________________ |
proizvedena aktovaya zapis za № _______________. |
|
data rojdeniya “____” _____________________ goda |
P�sle registratsii braka prisvoyeni familii: |
|
mesto rojdeniya _______________________________ |
muju ________________________________________ |
|
_____________________________________________ |
jene ________________________________________ |
|
i grajdanka __________________________________ |
Mesto registratsii ____________________________ |
|
_____________________________________________ |
_____________________________________________ |
|
data rojdeniya “____” _____________________ goda |
data vidachi “_____” _____________________ goda |
|
mesto rojdeniya _______________________________ |
|
|
_____________________________________________ |
Zaveduщiy (aya) organom zapisi aktov grajdanskogo sostoyaniya _______________ |
|
zaklyuchili brak “ _____ ” __________________ goda |
Pechat |
|
_____________________________________________ _____________________________________________ |
|
| | |
|
(2a-ilovaning davomi) |
|
|
|
|
|
_____________________________________________ |
Marriage record No. _____ was filed on _____________ |
|
_____________________________________________ |
In the marriage the following surnames were given to |
|
date of birth ___________________________________ |
husband ______________________________________ |
|
place of birth___________________________________ |
wife__________________________________________ |
|
_____________________________________________ |
Place of registration _____________________________ |
|
and __________________________________________ |
_____________________________________________ |
|
_____________________________________________ |
Date of issue “ ____ ” ___________________________ |
|
date of birth ___________________________________ |
|
|
place of birth___________________________________ |
Registrar _________________________ |
|
_____________________________________________ |
|
|
married on ____________________________________ |
Seal |
|
_____________________________________________ |
|
|
|
|
|
|
|
1997-yil 30-iyundagi 330-son qaroriga
3-ILOVA
(Vazirlar Mahkamasining 2003-yil 5-iyundagi 249-son qarori tahririda)
|
O‘zbekiston Respublikasi | |
|
O‘LIM HAQIDA GUVOHNOMA | |
|
Fuqaro ____________________________________________________________________________________ | |
|
___________________________________________________________________________________________ | |
|
________________ yil________________________________ oyining___________________________ kunida | |
|
___________________________________________________________________________________________ | |
|
____________________________________________________________________________ yoshda vafot etdi. | |
|
| |
|
O‘limning sababi ____________________________________________________________________________ | |
|
| |
|
___________________________________________________________________________________viloyati | |
|
____________________________________________________________________________________tumani | |
|
__________________________________________________________________shahri, shaharchasi, qishlog‘i | |
|
| |
|
| |
|
| |
Muhr |
|
| | |
|
| |
| | |
|
(3-ilovaning davomi) | |
|
SVIDETELSTVO O SMERTI | |
|
Grajdanin (ka)______________________________________________________________________________ | |
|
___________________________________________________________________________________________ | |
|
“ ______ ” ______________________________________________________________________________ goda | |
|
___________________________________________________________________________________________ | |
|
umer (la) v vozraste __________________________________________________________________________ | |
Proizvedena aktovaya zapis za № ___________________. | |
|
| |
|
mesto smerti: Respubliki_____________________________________________________________________ | |
|
_____________________________________________________________________________________ oblast | |
|
______________________________________________________________________________________rayon | |
|
gorod, posulok, kishlak ______________________________________________________________________ | |
|
Mesto registratsii __________________________________________________________________________ | |
|
___________________________________________________________________________________________ | |
|
Data vidachi “ _______ ” ________________________________________________________________ goda | |
|
| |
Pechat |
|
|
| |
|
|
|
(3-ilovaning davomi) | |
|
DEATH CERTIFICATE | |
|
___________________________________________________________________________________________ | |
|
___________________________________________________________________________________________ | |
|
died on_____________________________________________________________________________________ | |
|
___________________________________________________________________________________________ | |
|
at the age of _________________________________________________________________________________ | |
|
Cause of death: Republic ________________________________________________________________________ | |
|
_______________________________________________________________________________________region | |
|
______________________________________________________________________________________ district | |
|
__________________________________________________________________________________ city, willage | |
|
Place of registration ____________________________________________________________________________ | |
|
____________________________________________________________________________________________ | |
|
Date of issue _________________________________________________________________________________ | |
|
|
|
| Seal |
|
|
| |
| | |
1997-yil 30-iyundagi 330-son qaroriga
3a-ILOVA
(Vazirlar Mahkamasining 2003-yil 5-iyundagi 249-son qarori tahririda)
|
O‘zbekiston Respublikasi | |
|
O‘LIM HAQIDA GUVOHNOMA | |
|
Fuqaro Puxara ______________________________________________________________________________ | |
|
__________________________________________________________________________________________ | |
|
________________ yil________________________________ oyining___________________________ kunida | |
|
__________________________________________________________________________________________ | |
|
____________________________________________________________________________ yoshda vafot etdi. | |
|
| |
|
| |
|
O‘limning sababi Oliminiң sebebi____________________________________________________________ | |
|
| |
|
_____________________________________________________________________________viloyati oblasti | |
|
______________________________________________________________________________tumani rayoni | |
|
_____________________________________________shahri, shaharchasi, qishlog‘i qalasi, posyolkasi, ao‘ili. | |
|
| |
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Muhr Mor |
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(3a-ilovaning davomi) | |
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SVIDETELSTVO O SMERTI | |
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Grajdanin (ka)______________________________________________________________________________ | |
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“ ______ ” ______________________________________________________________________________ goda | |
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umer (la) v vozraste __________________________________________________________________________ | |
Proizvedena aktovaya zapis za № ___________________. | |
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mesto smerti: Respubliki_____________________________________________________________________ | |
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___________________________________________________________________________________ oblast | |
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______________________________________________________________________________________rayon | |
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gorod, posulok, kishlak ______________________________________________________________________ | |
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Mesto registratsii __________________________________________________________________________ | |
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___________________________________________________________________________________________ | |
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Data vidachi “ _______ ” ________________________________________________________________ goda | |
| Zaveduyuщiy(aya) organom zapisi aktov grajdanskogo sostoyaniya ____________________________________ | |
Pechat |
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(3a-ilovaning davomi) | |
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DEATH CERTIFICATE | |
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died on_____________________________________________________________________________________ | |
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at the age of _________________________________________________________________________________ | |
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Cause of death: Republic ________________________________________________________________________ | |
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_______________________________________________________________________________________region | |
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______________________________________________________________________________________ district | |
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__________________________________________________________________________________ city, willage | |
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Place of registration ____________________________________________________________________________ | |
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Date of issue _________________________________________________________________________________ | |
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