wniosek o wydanie zaświadczenia za granicę

wniosek o wydanie zaświadczenia za granicę

..............................................................................
(imię i nazwisko wnioskodawcy)
Linia, dnia ......................................
..............................................................................
(adres do korespondencji)
…………………………………………………..
(seria i nr dokumentu tożsamości)
…………………………………………………..
(Nr PESEL)
Do
Urzędu Stanu Cywilnego
w Lini
WNIOSEK
Proszę o wydanie zaświadczenia stwierdzającego, że zgodnie z prawem
polskim mogę zawrzeć małżeństwo za granicą z –
…………………………………………………………………………
/imię /imiona/, nazwisko i nazwisko rodowe drugiego z przyszłych małżonków /
data i miejsce urodzenia……..…………………………………………
płeć……………………………..obywatelstwo………………………. .
Do podania załączam –
1.Zapewnienie
2.Dokument potwierdzający stan cywilny przyszłego małżonka
……………………
podpis
Podlega opłacie skarbowej 38 zł
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