REPUBLIC OF CUBA

STATE CIVIL REGISTRY

MARITAL STATUS CERTIFICATE

I CERTIFY: THAT ASIDE FROM THE BIRTH REGISTRATION OF ___________________

BORN ON ________________, IN _______________, ______________ TO WICH IT IS COL-
LABORATED ON FOLIO ______ OF VOLUME _____ OF THE CIVIL STATUS REGISTRY
OF _____________ PROVINCE OF _____________, IN WHICH THERE IS NO SUCH AN-
NOTATION REGARDING THE FACT THAT THE REGISTERED PARTY HAS FORMAL-
IZED MARRIAGE.

OBSERVATIONS:
THE REGISTER OF THE STATE CIVIL REGISTRY OF _____________________ CERTIFY
THAT THE DATA CONTAINED IN THIS CERTIFICATION ARE IN ACCORDANCE WITH
THOSE THAT APPEAR IN THE INSCRIPTION TO WHICH IT REFERS AND HAS A SIM-
PLE PRESUMPTION VALUE.

CONFRONTED BY:
MADE BY:

AND AT THE REQUEST OF THE INTERESTED PARTY. THIS IS ISSUED ON __________________

THIS CERTIFICATION HAS A TERM OF VALIDITY OF 180 DAYS.

(Signature)

I, ____________________, CERTIFY THAT THE ABOVE IS AN ACCURATE TRANSLATION OF

THE ORIGINAL DOCUMENT, I AM THE TRANSLATOR OF THIS DOCUMENT FROM SPANISH
TO ENGLISH, AS SPEAKER OF BOTH LANGUAGES DO HEREBY CERTIFY THAT THE
FOREGOING ARE TRUE AND CORRECT COPIES OF DOCUMENTS SUBMITTED OR ARE
EXACT PHOTOCOPIES OF THE UNALTERED ORIGINAL DOCUMENTS

SIGNATURE: DATE: