Translation From Russian into English

COPY

Civil Registry Office of Pushkinsky district Form No. 15

the Committee for Civil Registry Office:
(name of authority in charge Of Civil registration)

CERTIFICATE
NO IMPEDIMENT
No. A

information about the person with regard to whom there is no marriage record:
(name of vital record)

(first name)

(patronymic ( if any)
12.5. 2002,
city of Moscow
(date of birth) (place of birth)

·The verification n was made for the period from May 3l. 2020 till April 7.2021 through
the archival fund of the authority in charge of civil registration.

Date of issue April 8, 2021

Head of authority in charge / S.N. FroloVa

of civil registration signature/ (printed name)
(Authorized Employee) (signature)

Stamp here (official seal)

Round official seal:
Coat of Arms of the Russian Federation * Government of Saint Petersburg * Committee
for Civil Registry Office * Civil Registry Office of Pushkinsky district *