ADUTIN- CUPSUOGPOPY Loman foto APPLICATION-QUESTIONNAIR 35x45 SUSUUSELP CLP AESANOSNEVANT GUSANO3TU UUPAELPGUY USHLULAK GUSANESUY VUPLUL PRUNE GPULPLOOGLAN) (ningdt) FOR RECEIVING RESIDENCY STATUS (FOR EXTENDING THE TERM OF RESIDENCY STATUS) IN THE REPUBLIC OF ARMENIA 1, UqquuGnuip, whimdp, muymnGinGp Name, Surname, father’s name 2. Qunupwghmpynip __ 3. BGGqyw6 opp, whup, mupoppyp Citizenship Date of birth 4, 00Gnywnd Yuypp 5. Unanmipymig Place of birth Nationality 6. Uygbumpyud Guywunyp & qpandinGpa — = Purpose of visit 7. CémmGhtqwG qpmp yp Family status 8. 16 muphi nwowd babluanh md, wqquiGmda, hoypuGeGp, 2666 opp, wetpup, mmupbphlp pos upaighmpynutn Children under 16 /name, surname, date of birth’ citizenship 9. 2ujwunwGh Lwepowtonpyadn b wrauUnsnGnd pwbmppud hesugainn Address in the Republic of Armenia and abroad 10. UGeGugph ubppwG ke hutwnp, bpp & nes YoqTpg E wpb Passport 's number 11, Stqtywgrw tal yupqur|pSiay unwGupmg htnn 15-opjw éuntytannud, puy LaywunaGh guGunybeam- PyuGnad pe Ynwatud pGubmpyuG Youn YumginhuiG ntoypout T-onjws dustyknnes wntqalwG nahn hG huyynGtyne wupunatuGnepjnG tasuG: Tam informed about my responsibility to providing any information to the local register getting the residence card and in case of changing my permanent residence in the Repu days term, in 15 days after of Armenia in 7 a 20 p. wipgwpbpphye yeugnbg Filled by (ounpgnmpyotin, signature)