The marriage certificate

Citizen Ivanov Ivan Ivanovich
born on 01-01-2016
the place of birth The Russian Federation

and citizen Smirnova Natalia Ivanovna born on 02-02-2016
the place of birth Kazakhstan

married __________

with registration thereof in the marriage register on 04-01-2016 under N 99999

Upon marriage the following surnames were assigned
to the husband Ivanov I.I.
to the wife Ivanova N.I.

The registration place Moscow

The date of issue 03-03-2016

The Head of the Civil Registry Office _________
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