Coat-of-Arms)

Rectangular Stamp:
Administrative Fee as per tariff Nos. 1 and 19 of the Law on
Administrative Fees amounting to ___ Dinars has been paid.
Round Seal:

SERBIA AND MONTENEGRO

REPUBLIC OF SERBIA

MUNICIPALITY of

BIRTH CERTIFICATE
In the birth registry kept for the district of BELGRADE under File No. 04659 for the
year 2004, the entry is made for the birth of:

Name (Sex)
Family name
Day, month, year and hour of birth
Place of birth and State if born abroad
Personal identification No. Citizenship
Data about parents Father Mother
Name
Family name
(for mother maiden, too)
Personal identification No.
Day, month and year of birth
Place and municipality of birth
Citizenship
Residence address
Additional entries and annotations:

Number: / (L.S.)
(Signature)
In: Date: (Signature of Registrar)
Round Seal: