0V 0 
Brelthe  Birth Certi?cate

Ama eisit'lint de bhun an Achta um Chl?ni Sibhialta 2004  issued in pursuance of the Civil Registration Act 2004

 

 

 

Eire Ireland
Cl?ruimhir Brcith a Chl?miodh i gCeantar
Registration Number} 58136? Birth Registered in the district of Cmom
i limiste?ar an Phriomh-Chl?mitheora i gConlac . . 
in the Superintendent Registrar?s District of croom in the County of L'menc
Uimh. Data Breithe Ainm Gn?as Ainm, Sioinne Ainm agus Sloinne C?im no Sint't. C?iliocht agus An Data 21 Sini? an Ainm Baiste m?
Date of Birth agus lonad na Mathar agus a Gainn thatha lonad Chdnaithe an Chl?raiodh Chl?raitheora tugadh tar~?is
Ch?naithe an Athar sloinne roimh an Athar haisn?iseora (2th na
phosadh di Breithe agus an
D?ta
No. lonad Breithe Name Sex Name and Surname Name and Surname Rank or Signature. When Registered Signature of Baptismal
Place of Birth and Dwelling-Place and Maiden name Profession of Quali?cation and Registrar Name if added
of Father of Mother Father Residence of after
Informant Registration of
Birth and Date

 

 

 

 

 

 

 

 

 

 

 

 it! {lava?le

 

 

m1  
WW

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Deimhnitear gur 1h iomslodh na sonrai seo 6 cl?rleabhar coinnithe faoi alt i3 den Acht um Chl?n'i Sibhialta molt/Certi?ed to be compiled from a register maintained under section 13 of the Civil Registration Act 2004
Eisithe ag Issued by Catherine Keane, GRO Dzita/ Date Of Issue 9 January 2018

Is cion tromchl'liseach an deimhnil'r seo an admin n6 6 a tis?id agus athraithc To alter this certi?cate or to use it as altered is a serious offence