ROUMANIE R O M AN I A ROMANIA

CTRTI:FIC..'A.T D'E V'EC'ES

CERTIFICAT DE DECESIDEATH CERTIFICATE
Seria D.11 Nr. 214455
Serie/Series No./No.

DATE PRIVIND DECEDATUL

0 onnees conc;emant le decedel Cod Numeric Personal 1~1s·31 /, a.~,] IQ~I O OJ 181
0 ata concemmg the deceased Numero personnel/Personal number S A A L L Z Z N N N N N C
Numele de familie
Norn/Surname
Prenumele
Prenom/First name
Sexul
Saxe/Sex

Domiciliul
Domicile/Domicile

Data decesului , pes/Place qf death

Date du daces/Data of death
J4de\uVDepartenWRVCounty
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DATE PRIVIND PARINTII / Dor,,n~e~ cor cernahtJes p~n_ts1fr:,ata concerning the parents
Numele de famWe ~. - - ..-- -- I !
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TATAL Nom/Surnam,e '\

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Numele d~ ~amilie\
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MAMA Prenumele ' 1
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Mere/Mother '
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Prenom/First na e ., · /, "i" \

Act de deces nr. _______,_O','..

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Acte de daces no.I de/from , . I ' ( • '

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Death document no. • • ' • fi.i-,
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inreg1stra a_____________ _ .l · • - ·- - '- ----·, ----7- l...

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enregistre a1 (Localitatea/Amba;;ada/Consulatul) _, (Jude\ul/Departement/County)

registered at (LocalitelAt'Q__bassade/Consulat/Pla_ce/Embassy/Con~late) '
Men~uni ----------~---------- __________________________ _

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Ment,on'sl Menbons - '

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