*This translation template is to be used for US passport/report of birth applications.*
CERTIFICATE OF ACCEPTANCE OF DIVORCE REPORT
DATE OF REPORT :
HUSBAND
NAME :
DATE OF BIRTH :
PERMANENT DOMICILE (HONSEKI) :
WIFE
NAME :
DATE OF BIRTH :
PERMANENT DOMICILE (HONSEKI) :
SUMMARY OF REPORT :
Issue # :
This is to certify the forgoing report was accepted on
Issue Date :
Title :
Name :
I certify that the foregoing is a correct translation.
Translator's signature :
Translator's Name :