H 39199 Name and Surname of Father and Mother Calling of Father and Mother Residence of Father and Mother Name and Surname of Witnesses

של האב והאם משלח ידם של האב והאם Certified that the above is a true extract from the Register of Marriage kept at the office of of 707 39199 in the

Jeאה וריק Certified that the above is a true extract from the Register of Marriage kept at the office of of 709/39199 in the District. במחוז התאריך