OFFICE OF THE MUNICIPAL MAYOR
OF [MUNICIPALITY]
                  DISTRICT OF SAN SALVADOR, EL SALVADOR, C.A.
                               FAMILY STATUS REGISTRY
Record Number:
born at                                    hours and
minutes on the
                       In
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Information provided by                                     who
Claims to be the               of his newborn              providing
his
....................................................      issued by the
                                                             For purposes of Art.
192 C.F. this entry is recorded by [Name].
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[Place], on the                         of
of the year Nineteen
            [signature]                                      [signature]
       Informant’s Signature                      Head of the Family Status Registry