[SEAL] [BAR CODE]

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UNITED STATES OF MEXICO
Mexico City

BIRTH CERTIFICATE
ENTITY DELEGATION COURT BOOK MINUTES YEAR CLASS REGISTRATION
9 1 8 ## ## 1985 NA DATE
01-01-1985

CIVIL REGISTRATION CIVIL REGISTRATION CIVIL REGISTRATION CIVIL REGISTRATION CIVIL REGISTRATION CIVIL REGISTRATION CIVIL REGISTRATION

REGISTRANT’S INFORMATION

Name: JANE SMITH Sex: FEMALE

Born: ALIVE
Date of Birth: JANUARY 1, 1985
Place of Birth: SAN LUIS POTOSI 48 DISTRICTO FEDERAL

PARENTS’ INFORMATION
Name of Father: JOHN SMITH Age: 30
Nationality: MEXICAN

Name of Mother: JANE DOE Age: 30

Nationality: MEXICAN

GRANDPARENTS’ INFORMATION

Paternal Grandfather: JOHN SMITH

Paternal Grandmother: JANE DOE

Maternal Grandfather: JOHN SMITH

Paternal Grandmother: JANE DOE

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This certification is an extract of the act whose data above is required and SIGNATURE:
which is issued electronically and in a manner based on articles 48 of the
Civil Code for the Federal District and Section VII of the Regulations of the
Civil Registry of the Federal District in this Mexico City. [SIGNED NAME]

C. Central Judge of the Civil Registry of the Federal District A DECEMBER ##, 20##

[CODE NUMBER]

CLAUDIA LUENGAS ESCUDERO, LICENSED

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To verify the validity of the content of this copy visit page on the internet:
http://wwww.consejeria.df.gob.mx/rcivil

CIVIL REGISTRATION ########

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I, JOHN DOE, certify that I am fluent in the Spanish and English languages and hereby certify that the above information is a true,
complete, and accurate translation of the attached original document entitled “Acta de Nacimiento.”

Date: May ##, 2018

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JOHN DOE
123 Anywhere Street
Houston, Texas 77002