MINISTERUL AFACERILOR INTERNE · a) In cazul prevazut la litera d), la intocmirea actelor de stare...

18

Transcript of MINISTERUL AFACERILOR INTERNE · a) In cazul prevazut la litera d), la intocmirea actelor de stare...

Page 1: MINISTERUL AFACERILOR INTERNE · a) In cazul prevazut la litera d), la intocmirea actelor de stare rornane, ca urmare a transcrierii In registrele de stare civila rornane a certific
Page 2: MINISTERUL AFACERILOR INTERNE · a) In cazul prevazut la litera d), la intocmirea actelor de stare rornane, ca urmare a transcrierii In registrele de stare civila rornane a certific

ra at nt

oi

ni

ivi l

oc I

MINISTERUL AFACERILOR INTERNE

Directia pentru Evidenta Persoane/or si Administrarea Bazelor de Date

Indrumarea

nr. 9 din oB,0Lj.. 2aJ4

cu privire la anumite aspecte referitoare la documentele de stare civila elibei te de autoritatile din S.U.A..

1. Ministerul Afacerilor Exteme - Directia Relatii Consulare a not fie institutia noastra cu privire la urrnatoarele aspecte:

a) Autoritatile americane cu competenta in materia actelor de stare civi a I

emit certificate de stare civila originale. La cerere, acestea elibereaza titularil sa persoanelor indreptatite doar copii certificate ale documentelor de stare c vii certificarea fiind efectuata de catre autoritatea emitenta,

b) Copiile certificate ale actelor de stare civila sunt tiparite pe foi de 1art (color sau albe), unele avand elemente de siguranta, cum ar fi hartie cu fili timbre cu holograme, timbru sec sau cod de bare si care contin, in major cazurilor, mentiunile de certificare copie ("certified copy") ale institutiei emi precum si semnatura ofiterului de stare civila. Spre exemplificare, anexam cop i a unor certificate de stare civila emise in statele California, Michigan, Ill' Wisconsin, Pennsylvania, Connecticut, New York.

c) In unele state, copiile certificate sunt insotite de 0 certificare suplime aplicata pe 0 fila separata a certificatului de stare civila (cum ar fi certificatele in diferite districte din statele Michigan, Florida, New York, Hawaii etc.).

d) Rubricatia formularelor pentru cele trei tipuri de fapte de stare (nastere, casatorie, deces) nu este identica in toate statele si , de multe ori , din ac std lipsesc inforrnatii considerate esentiale in rubricatia actelor rornanesti (data si nasterii, numele complet al parintilor etc.).

Diferente proeedurale pot fi intalnite ehiar si pe teritoriul aceluiasi st intre regiuni/districte diferite (numite "County").

e) Celor doua rubrici nume si prenume care identifica in Rorna ia persoana Ie corespund in S.U.A. 3 (trei) componente distincte, fiecare format , d regula, dintr-un singur cuvant: prenume ("first name"), al doilea prenume sau Ul I de mij loc ("middle name") si nume ("last name").

Se constata insa, de multe ori , ca, In formularele pe care le completea a I fata autoritatilor americane, cetatenii tree In mod eronat numele avut anterio sa

, ,

Page 3: MINISTERUL AFACERILOR INTERNE · a) In cazul prevazut la litera d), la intocmirea actelor de stare rornane, ca urmare a transcrierii In registrele de stare civila rornane a certific

prenumele tatalui In rubrica "nume de mijloc", intampinand, ulterior, dificul at i

d I I

on

transcrierea certificatelor respecti ve In Romania. f) La nivel federal, In S.U.A. nu exista 0 uniformitate legislativa

reglementeze tipizatele formularelor de nastere, casatorie si deces, In ac cerintele unor practici internationale. S.U.A. nu a semnat Conventii interna care 'sa duca la armonizare~ formularelor la nivelul fiecarui stat S.U.'I., autoritatile locale statale resping, in gene ral, ideea modificarii formul arelor act

2. In considerarea celor notificate de catre Ministerul Afacerilor E precizarn urrnatoarele :

a) In cazul prevazut la litera d), la intocmirea actelor de stare rornane, ca urmare a transcrierii In regi strele de stare civila rornane a certific te l de stare civila procurate din strainatate, devin incidente dispozitiile art. 41 aq . din Legea nr. 119/1996 cu pri vire la actele de stare civila, rcpublicat , modificarile si cornpletarile ulterioare. I

b) In situatia prevazuta la litera e) , la transcrierea In registrele d~ st civila rornane a certificatelor eliberate de autoritatile din S.U.A. , In cazul In c e,

'

urma analizei documentatiei existente la dosar se stabileste faptul ca tit la certificatului de stare civila nu are prenume compus ci la rubrica "nume de ml'lo este inscris numele purtat anterior sau prenumele tatalui , actul de stare I ivi rornanesc se va intocmi mra a se prelua acest nume/prenume.

Imputemicit DIRECTOR, e politic

IV

al

Cornisar-sef

Gina-Laura (£USAI

Tel. 02 1-4 13.54.42 ,02 1-746. 70.47/8/9:Fax. 02 1-4 13.50.49 E-mail:depabd(ii:rnai.gov.1"0

Str. Obcina Mare Nr. 2, Sector6 RO - Bucuresti

Page 4: MINISTERUL AFACERILOR INTERNE · a) In cazul prevazut la litera d), la intocmirea actelor de stare rornane, ca urmare a transcrierii In registrele de stare civila rornane a certific

State of California Secretary of State

APO$TILLE

(Convention de La Haye du 5 octobre 1961)

Country: United States of America Pays I Pais:

This public document Le present acte publ ic lEI presente cocurnento pUblico

has been signed by Dean C. Logan a ele sign~ par ha sido firmado por

acting in the capacity-of Registrar-Recorder/County Clerk agissanl en qualile de quien actua en C<llidad de

bears the seal I stamp of County of Los Angeles, Slale of California est revetu du sceau I timbr e de y esta revestido del sene I timbre de

Certified Allesle I Certificado

24th day of May 2013 _ .

at Los Angeles, California 6. the I it I en le/eldla

by Secretary of State, State of Cal ifornia par I por

:. N° 56137 sous n° bajo el numero

I. Seall stamp; Q 10. Signature: ~ 6uW<:A-Sceau 1 timbre : Signature: Sello I timbre : Firma:

lis Aposli lie is the tril ingua l model AposUlle Certificate as suggested by the Perma nent Bureau and deve loped In response 10lhe 2009 iecial Commiss ion on the practical operation of the Hague Aposti lle Convention. "" lis Aposlille only certifies the authenUdty of the signalure'and the capacity of the person who has signed the public document. and. iere appropriate. the identity or the seal or stamp whidl the public document bears . . lis Aposlille does nol certify the content of the document for which It was Issued . lIs Apostil1e ts not valid for use anywhere with in the United States of America. Its terr ttooes or possessi ons. I verify the issuance of !h is Aposnne , see : WYtW.so.s.ca.govlblJslness/nolarv/llDOsliIJe-searchJ.

- - ----_...-- - - ------ - _._--_.__._--_ ._- - ­

lIle aposlille est Ie model e d 'Apostille trilfngue tel que slJggera par Ie Bureau Permanent et elabore en repon se it la Commission eciate de 2009 sur Ie fonctionnement pratique de!e Convention de La Haye Apostine. rne Aposnue aU8S1e uniquement ra vsraells de la signature . la quatne en laqueUe Ie signataire de racte a aoi et, Ie cas ecne aru. Jenlile du sceau ou Umbre dont cet acte public est revetu , sne Aposune ne cerufie pas Ie contenu de l'acte pour /equel elle a el e ermse. .rlilisation de cette Apostille n'est pas valable en I au Elal:s-Unis d'Amerique. ses territoires ov possessions. ette Apost ille pout ~tre verifiee il.i'adrasse suivante: www sos .ca.qovlbusinesslno\arv/aposlille-seerchl .

sta apcsuua as el rnooeio trilingOe Certificado de ApostiUa s"9un 10sugerido por la Oficina Permanente y cesarrouaoo en respuesla la Cornisron especial de 2009 sobre et fundonamiento practice del Convenlo de La Haya sobre AposUlla ;Ia Apos tilla certific:<l onicamente la aUlenticidad de la firma . la calidad en que el signatario del cocurnen to haya aciuado y. en su ISO. la idenlidad del se llo 0 timbre del que el documento publico este revesnoo . sta Aposuua no certi fica er conlenido del documento para el cuaJ se expidi6. o es valido el uso de esta Apostilla en Estados Unidos de ·America , sus terntonos 0 posesiones sta Apostilla se puede verificar en ta direcci6n siguiente : www.sos .ca.goylbusiness/nolarv/llPoslI11e ·sc §rch/ .

;.;JSlal<: Form Nf-40 LA( 1112011)

Page 5: MINISTERUL AFACERILOR INTERNE · a) In cazul prevazut la litera d), la intocmirea actelor de stare rornane, ca urmare a transcrierii In registrele de stare civila rornane a certific

'3 OA'~ Of 81FUri lolIl>n l l 6.llV,vt.oJl

121 29 /1 %7

FO HhtliA

:CHI NA

r ,/1/"/

I ".\.IIOoOAOl~ I.lQIo • ..e..t,..tlll:.1')

, eW{e.r;r ....L f 1'10 O""~ 1111.t

: ~,u"&.JD ,tJ",.r"",,,,­

-­ 1-- /2 00 0

" M O...U - """""'''' 0., I"loVo: - ~ ._ /-­ -­I'" 'Oo..V";: ........"<-tu m

• ns srATE 01 etA l h

no Jll.UO£N\..A$lt',u,l1t ' "I "'QoI,(~ .. II_ 'l'CI

OCT 1 6 Z012

llllllllllDI • 001 922 8 1 8 •

I 1>( ......., OJ CO<,t(TY e~f'"

;Conny 8.He Cormack

; 2"8 ~$S --'·1Ll1-o ......1l

~f1 ~ft· I lID o\OOIR!l$ _ • .,..... MID..........

:gbJ> 1I,'tt 111.""11

I 'A-I CIT"'+' tie( ltD-cOQ( 1 ......0 CQJIlo( tv , OU1KJ( I I j c.a.,I~rl,.,t·"4fl

, BAI<£RS r ELl: i ~i} )J ~ I !'ERN

In "'"'-"'ft_ 0' 1

'&' W' ",""",1h.AC{ fHO'£O 8 '(- - •

1I'Itt~-"""1ll" -.(,.41

00 O()(Ah. o "''''00.U1000< O.-.o>E. r

I 190 IJW<Il(.IC.-<POf'~SS()llltlll()uS'ftf'

:HEALTH CARL S~ R V1 CE 1 " . """( 01 B-AI.. 111A. fUll """"-CIEI'("'l.IW£ QII wortiER

:ROAA/;IfI !ON£LA 8ERDAC

I 178 WJOD(t I I

UCENSE AND CERnACATE OF MARRIAGE ~ bl' LfG ...[ ~ NOrRASo.Ptt1 ......mt:W11 OR.OTht:R AllUu.no,",s

I] 10612007

,:.0 UCUCSl UJ'lRU I "O"'''' ..."f'tJt,II:

1..... 1Q C8fll ~:n.t _ ".'."CIl!'r d ' '''o ~ "III'I\t\h ~I-"l!y o.r-

~.CL,Q:1'-DEA.Nc LOGM~

Reg'Sl'Ill.Aeco,,,,,,. oo n~ c.....

s:~ Til"" ( 0'V1 UI.J\ ~ 'f 1l.....U pt '~ UI'\ (tlCIIIH"!.l LJ(.IUrl d, \ I 'Y)" UIool Lhr ~~ Jilt! ~ lutl,L1'l' ct \he' RfC., ,,uU .Irc ~ ~~••.:;!..~r ll~

'l'IC ''''' ~...,...o _~O_.4rCJ~P~"_1'\ 1~' hot ' QllC GOoooQ -O--........c'O'l-.c'II'J'C)",.,. '0 n-( Nil 0# ~~0G.t """Ii)

MIJlf' l_'JoooO"CQ,tr.,. t",<~ IolClII'IOtW;f"•....,.. .. l:(Of .. uc:(to:WI1~tO""'4itNQO«"C"'~~"QltAtC.kQJoIIO ...a ... t4lUortOJ ""'."¥o<;.C"

4 29Ul I 90 I 752 I

HIM POY LIM

1& 1.....f C. 'I' l rI .. '_1 t """ ~ -..:O.-cJl'MOc.IIOOw_IltJC)lloC'V ....... ..~ .. .t.U;~_""'lo.(~O< ..... ~1.'l0''CJ.401~

- - - .. ·7-===-------~:=_:,.,.,.._:==_=E':=_:_=_:__=~---==----+::_~___:::_'_;_;:,...:_,_.c:c:_:= = =_

l"JlNI'IG£R

PHYSI C I AN 11.. ruu~CW' ·~

~T~' 'U"h~Jrr4I' 1I ...... """"C ... 'O,.~~DlAY#Olftoo()llo,i('OIf" ............ ot T.....e:ttU( r;~_QlItIIM 'O"'.QfIW .. ~tt_UO- Ml_'oof n ...'''' ~ e.-"o-... ro~('-'Il""'"--"Q CllI' ''''a.IOI4. __0'''lII$ONS "~~lIft.'QIt'lo(~O'tM.~ICt"'ut.tQIII'llt

12 6 [ 0 GR~AT COUNTR) OR -;-6 ~\IKG ""UO'f.t-!lS ~ D-lHIIbl_1

M[!<CE:J\ OUMITRU

\ I \1, O,l"VlT

GSlOO'o< HRs.:- l

00\'" 1~~,;.,,~==:~=----- -_...J.= 7:i:. ====~:;.:.;...;~~ r:..;.....:.--=--.:.-.:.- +.,,""'"ill;;;-::;i-;;~;;;;;; ==.

~AI t)E

ti- RSO" " l • OAt A

Page 6: MINISTERUL AFACERILOR INTERNE · a) In cazul prevazut la litera d), la intocmirea actelor de stare rornane, ca urmare a transcrierii In registrele de stare civila rornane a certific

DEPARTMENT OF PUBLIC HEALTH . . .

COUNTY OF IMPERIAL .EL CENTRO, CALIFORNIA

nus CHILD .

. -'. HAME OF CHilO -

-,

ARST ( a~ ) . r •

- ·11_" . - '::' >.

• t

CERTiFICATE . OF LIVE B IRTH ···. S T A T E OF CAl.IFpRNIA

• USE BLACK INK ONLY

0 118. MICOlE

_ :

1 2004 -' 13 00117

PUCE OF

. BIRTH

of

.. '-,

.... t.

--~ : " .. - .. ~.... ~.

· v

,r .- ­.,. -:,." .: -.

_. j:;ERTIFIED.CO·P'Y OfVJTPtRECO ~O.~ ': " . • • ee- , ;.,: A'; ~ CAUFORN~, 9OU~TY-OFIMPEAIA~ . • l=:2

i DO HeREBYCERTIFYTHATTHE ~R EGO ING IS A TRUEAND CORRECT COpy OF THE.OR IGINAC~ECO~D' AS FILED IN n ils ICE. . STEPHEN W. MUN .0. M.P.H., MS.0

- LOCAL REGISTRARDATE ISSUED . A\,IG:.O 3 200(, ) · 1~~EI'i IAl. COUNTY, CAU~RNIA

This copy is not valid unless prepared op engraY~ border, . -, ' . .

. . . .. . .

Page 7: MINISTERUL AFACERILOR INTERNE · a) In cazul prevazut la litera d), la intocmirea actelor de stare rornane, ca urmare a transcrierii In registrele de stare civila rornane a certific

-- -------

COUNTY OF LOS ANGELES . REGISTRA:-' ·RECORDER COUNTYCLERK

CER'T1:!;:~~ DEATH 39419036271 ...- -.....: _....".... -.-..... .......-.. ---­.. I' ,...

1 ....... 0"~~ ...... - Ilt,.,...,,,-.,1' ''-' .

,- ~ ........... Qr _ ..... "" •• / C C ' · M I . r-·U\ilOO'-..oo .... / O . ~ ' (. · . I' 00.. ­r '75 • , I - .... 1-- 1-­ III 08/17/1994 015010/0' 1 Q'~ , ... -..c.. _ - ._ <_ ,'<11. ••·a.... o-~ I'" _......­_ I'O....... ~IOO. I"-..- -'. IiJ-.-...... , e 10 ,.. __ KAP.iU EOl\Ol'IAIIIA 555·7 ~-95oo Ie ...-- - -- ­.... 04 ,_­ !Xl _ , ,, .- ~;;ElWlS

CAUCASIAIl !"n:.~ HOSI' ITAL .,.......- I '· ...- ... ~. ~..;...----,... ---­

"f:D1CINE I 10MUCLEAR OPElATOR- a=o ---~ ...... tr:_ _ ., 79 ..,TUOIlSOll Avtu .....

...-co .. - 1--- 1 - -1;- 1­ " 'M~ . nmTn ,..TTY 9U04I~:-:""v,.<

M

- r-n ----------_._ ......_ ­... - ­C!OItCIITA Il.UUHIIMII IIIrE I 4229 VIIJCIJISOiI An •• STUllIO CITY . CA 91604 _.......

-_-~

C!ORCIITA_no_ .. ~ ... --- -~

, .

P1.01U:..... - M_........·'

l,u"'AN[I. w._ .. __ ... _" .. ..

KARlA - II'DEEANU ROHAIIIA. -~;;~; ~~~~. l-l'~;;S~ ";:\I::;ORIAL PARK, -q

LOS AlfGELES, CA 90068

..- ­ .., '.... ----­ .... __ 0Jl#-......- .11 il.,D. ~

.. . ..<...-ooon

.-. ­ BUR IAl. ~ ~ "1­ 7)0). ­ 4ooIi._ .. _ - "---I"7r~-~ 'OS/'i9il994........- ­ mUST LA\I1I HOI.LY\IOOO KILLS r -90A • ( ~ 'DI .~o- __ I'O·pn -,=n....IO= Fxi": n__ -~.

~ RESTDAIICE :.os AllC r:W;s

'" ._- ---....-..-­ ._-...... 4229 I/ILXTllSOI AV! . STUDIO CITY

"".--~--..- ...... ___ ..-"­ .... c.._l;a

~~ ,......-_.., .~

8'_ 0­~.,. - ­c.... ... t'\('l:~-r .., .£. ~"f~"'\(,. {"""'Ct.N~A ,.., ..... n·s

-~-....... - .. O~ e­

' Ih-:~- ....... ""Q..... ,. ...

'''rl-~-rlOV. "0 ~

'u ~ ' IlL _~__~'O_t .. __....p.a"90 O)c.,..o.,w.~.. '07

~"a_._...",._.._~_~ t0'7_II'" "_~·"",,OO'~"C!"'O"OoCIJIl·U

'/IlS . wl-,'I'l'u, I'rvabu<\.. 0"1 Iio/~qIt ... ~_. ___ .. ___

'1:V7:-e-­ -c:~~~~~ , I t " _ ., 1II'.. ... / 'f. C ·• • ....... ....--~ ..,. .......... ­ .....

.... . "V...01"'" /Ylt> ; CK t v« /q4...... 'UI!CJI '..,..._ .......... e.c.- .......---- ,,""- -.:-:- ...... ­c--...

,;j:;,,;~ : ~I.:~~ ~ "­~ ----. -. _ --.. . w- DAVT0 T.T.VTJI H n 7"'" I!lllrol ST. \OX(JWl arus 9111\1CA

~ _...... .:...-... ~.-::--- n_n"'"J'" - ­ ··"".. ·1 ...·- 1,,"' ...... - ­-- ­t'9 ___

0_0_ 0_ I ~ ~ __ec----.-*, __",, __

"'*"'-' o ~O =-_0 =::.::.­--y ' -. ....-.u._ ~ ___ ~...- _ CI'f'O _.~

;

'1 I" __ "~_"""",,-=---

-["'''~~~ \'''' - .I "' U _ ~ .. ---. ­,~

"" 10'. . I- iC I" I" /' i' I ~ " •• • un< •

, <... .......... ......(,1

~.......

. ..--.- ­- OI'UA ....... - "Akr.1\I 'UH

"' ..... ­

-- - --..._--­

_ ,•• - . :0 • I .nr.- .

:/,

,, '­. 1 "

~

,..

--

1

Page 8: MINISTERUL AFACERILOR INTERNE · a) In cazul prevazut la litera d), la intocmirea actelor de stare rornane, ca urmare a transcrierii In registrele de stare civila rornane a certific

DEPARTMENT OF STATE

APOSTILLE (Convent/on de La Haye du 5 Octobre 1961)

UNITED STATES OF AMERICA1. Country:

This public document

2. has been signed by: C. Myers

3. acting in capacity of: OakJand County Deputy Clerk

4. bears tire seal of: Oakland County Circuit Court

CERTIFIED:

5. at Lansing, Michigan 6. the 16th ot.october, 2013

7. by Secretary of State, State of Michigan

8. NO. 11841l-1-340762-0GS

9. SeallStamp: 10. Signature:

~'!!~ Ruth Johnson

~._._~., "-- --.~ ··.,,··.. ·6 ............... ~ ... '-'I .l~ .. _.I.<I.. ajl"" 1~'.JU PYof the record now remaining in . . fli. ~ Cl Llt:UJ, uu JJtti"l:-D\- cerurv tnatrn) U lee - '~.. tne foregOing IS a

Page 9: MINISTERUL AFACERILOR INTERNE · a) In cazul prevazut la litera d), la intocmirea actelor de stare rornane, ca urmare a transcrierii In registrele de stare civila rornane a certific

CERTIFICATE OF DEATHCF _ 1899705" ,"

.....,. ~. ' . '

" TY . V1 l V' G[ OR rcw..~ ...· p 0' Cv.

Own Home

1394 Tul l Dri ve 5 ~'Ui l "" \ ~ ". • ~ I' . ~ ....-.

Unknown

l Of.l~ 1'"",~ "'W., ...... ~~....,...;. Jo,J

C ,,,,s,D( ( 1- ' I)4l' ·.."I lL.J-C1. 0 '

~ '"lIP 01 Water f or d

Homema ker

Soitoc

I':.. C1JClRt: H r ~'<l.. let­ ,c0\J"rt1l " SUI[

48327

362-86-4744

Michigan Oakland

CI O b ( ,.. ' 'S ••,&1""

~ 8 !A' .... t; S ,~J,I,( j t".,J! J./. ~~ ton"

Constan tin

,.

1\

~ I kFO~ a.t ...,." S "tAIvol t ~ t , t!tt : fJ · ~.~ ~ """ ':'1,.,::; "C ;'Q'{~~ /s,....... V'd It"fflt!'f.t ... ".,, ·fJ q~ N"'."'l'N' C"f ,, ~ oi;.... S'.U'.I~ Codd ,. Mrs . Maria RaL iu 1394 TurL Dr ive Wa terford , HI 48327 n .. PvC( or t-V'O ~· t tC'" ,~ ., .,.~, ~.~-,

Ol'"",.,.. ~"

' i U liHOO or OISI)QS IToQ"f _ Suo...t O .......t e .. ,

Ottawa Park CemEtery Cl a rk s t on , Nl ' 1

2S J.t"yr "'''0 .... O(· RE!~ or ' ...,:1\.'" RIVERSIDE CHAPEL I 5630 Pontiac Lk.Rd . ,\>.'a ter ford , MI 4832

I~ U~ '4I , ..... ~ . ... r- .!!.2.! " " Q( t .,.. • • , , " L ll (lP'ty oPt' c~ ... ,...c: " " *! I ~-~-JI o-...... ~ I""": :.. . •

." " r0:"' .( ( , ( f .r_. J . ( 0" 04 ____ _ ___ _ W-fll!:..crthCQm~ lf cat 1QD o f l ympho i d' ''' '''' -C: • )~..l "

I I

----+- - --11­,

......., #-= r " I ~ s.- ::a '." I" ' : : ...

JANUARY 9, 2002

(,." i ) ", bcl- ' {:/ _u - " #' " .,.. --no' " I ...., !'? ,. .... -..c'" 0(-: .tl t"Ior .. . )1"' . : . ; ~ ... , "" ' I ~ • ""' - 1"/ ".

] ]1 . ,·U' ItV- . "',. ..... - . ~ t 'J '

l'" o: l':' L ~ , 0

06326

;r. L'C( " U """ Wi ( R , l .. r #tW't '

D. rTTRALA}

]). P".. ...o,,; [ 01 1hAtlt'

Buria l It ...... ow.. Do-\.a ' <On 0'tJv.. 'UWt( ~J)

X "~ r I ( "4 '" "wco t ~' l t6I'"

"'.'1 . , f ~ ""·" 'J._t 1 1 .- ~ c ,..c •• ~ r " J OA .....v ."ho ' <01"• •

STATE OF hflCffiGi\N COUNTY OF OAKLA3'\D

T, G. William Caddell. County Clerk for th E' County of Oaklan d , Clerk of the Ci rcui t Cour l thereof. t.he MUl e: being 8 court of Record, lind having II Seal, do hereby ct:lt ify tha t the- foregoing is a copy of the record now re mai ning in my office.

1... Tast i r-iorzy, Wh .:?!'c,' !. 1 hFl" P herountn set TTl \ ' hand and Rl1ixed th e si-al of Sil i d Court

th is ..lltlL _ day of January , A.D. 2002

Page 10: MINISTERUL AFACERILOR INTERNE · a) In cazul prevazut la litera d), la intocmirea actelor de stare rornane, ca urmare a transcrierii In registrele de stare civila rornane a certific

: ,

V2CJ20 1)

DAY S

-~

L ~ 'Eh In u S .\ H ~ D

r·)Pu ~ ") NO

r.-..A l "or N" T ~ '

1157AM

j

J. r~;.v :..,•.:.. , ~ . ") "-ltf'o ."\J=o. " SVH: -,.

0 '"n, C4 (1 "1" JUNE ze 2011

OATE ISSUEO

HOMEWOOD IL

CHICAGO. ILLINOIS MEDICAL CERTIFICATE OF DEATH

MEDICAL EltAMINE./l 'S CASE NUMBER 0(14JUL 11

;" : .f .... , LA':t1 r.1R ! Ht.oAt

77 YEARS

fUl 4 TEJ:Al LOWEFii :. .... TfU: ~ 1 7I E S '. \l() U r-~ O

Th .s », 1(\ I· PII Ii '. Ih ' "1,_ rs . 0 : '0" t'1'1U j "(.' r . 'r;t j ~ QPV fl on ..!'t: ,-,r::c !·..1 r tt·~ , (1 "!e- ' , 0.1>­ th . • ' ,­ - . ~ D· . , 1.... oJ rl l :>' "u ~ltc 1-1 '°.·1' "

"'''-'-'' 1 SEPSIS

COUNTY O ~ DE A T""

COOK

C' TYOR ' C, ','l'\

CHICAGO

~2S~ N KENMORE A VENUE

~ .L.C. E (j r O f ....r'rt

INPATIENT

'ATE ru.e NUMBER 2QlI00931>1

UNKNOWN

;'Ul'oERAL H (j M (

COOK COUNTY MEDICAL EXAMINER, 2 12 1 WHARRISON S T CHI':AGO IL €OO12

, ~ r om.t.:.)" T S ,. ......'1

JANICE SMITH

'J€l HOO 0 + r)t s :l t ) :"..rl\.....'

BURIAL

r. OUNi"'( I ~ ~ ;' · l

COOK I IL

CAUSE OF DE!'TH

l.:J,h T ;1 C""f'j' t:.l "'" .Jon illc.nr (CJnd,lI C1tUl c an7::b<I ' i rrr; ro ckt..tll l .... ,l l ~,.l I t " ·J '''' ,''= '' " e ; kI'1' ''' "J~ ....H 1 .• , .. ~ ,~ ~ i ,

HYPER TENSION

HJ"IAlf P'o:I::GIolM'l."'Y $ ':';" t,: !.

NOT APPLICABLE

n AI r '.I' ("'JURY

N.4J.4 E ,l(JUf-l t;:SS ""0 l ' OP ';OPl: Of P f tt SG ~ . QWJU li NG !.' AiJ ~ l Or cr ,\l "'i

OLUMUYIWA IOOWU, Sl.O WE S T IRVING PAR K RD SUITE 302 CHICAGO. ILLINOIS 6::06:::,::13=­ -.L_ === =­ --!

,:,f1EJ.;O l j-.;£[',.£CE:" Stc ·

YES

(#f RTiF ~ :;

PHYSICIAN

.'" "

Page 11: MINISTERUL AFACERILOR INTERNE · a) In cazul prevazut la litera d), la intocmirea actelor de stare rornane, ca urmare a transcrierii In registrele de stare civila rornane a certific

• • • • • • • • • t

io'! ...,J 0i <'J

c» . ­f

I to­~I 0

! f 11

i I

-0 ::>i '" <II .!l~ Qi~ ;:;

L ~ I Q

2 CC;'5 0,; <::T

,I i= ~ _:

df r-I; CD CD (Y)

Mr i~I! rl.. 'i !i . £,!!-'"' •~a

i .; f~

_0

I , _

j I ; I--!-j --l I ~ : \

" I ' : ~ . l =:

! I 1 : r j II ~ . ~ -' Jf .; 1 Ii of

'1<::I~ AJ (, t ; -I3SY:l ll ~ l.ln:> :Q":) . · c:> rn.n..,,1"~-" '5 1.'l. JD 0 'l W' J S" ·n OZIt Z! 9

p.:n 1"10 11 no ad popoocr 91 , I -""1 \

i

~ II I J ~ l ~! :i· ~ 0 e hi

L...-.'::"::":"'~~C-..L... -J

r • • • • • •

Page 12: MINISTERUL AFACERILOR INTERNE · a) In cazul prevazut la litera d), la intocmirea actelor de stare rornane, ca urmare a transcrierii In registrele de stare civila rornane a certific

APOSTILLE (Convention de La Haye du 5 0ctobre 1961)

Country: United States of Amer ica

This publ ic documen t has been signed by MICHAEL WOLF

"'d ing in the capacity of ACTING SECRETARY OF HEALTH

bears the seal/ stamp DEPARTMENT OF HEALTH, COMMONWEALTH OF PENNSYLVANIA

Certified

at Harrisbur g, Pennsylvan ia 6. The 10th day of April, 20 13

by Carol Aichele, Secretary of the Commonwealth of Pennsy lvania

No: 2013 10161

Seal/ Stamp 10. Signature

Carol Aichele

.:;. ",. .,'

lis Apostille only certifies the authenticity of the signature and the capacity of the person who has signed the ubi icurnent, and, where appropriate, the identity of the seal or stamp which the public document bears.

l is Apostille does not certify the content of the document for which it was issued.

l is Apostille is not valid for use anywhere within the United States of America, its territories or possessions.

Page 13: MINISTERUL AFACERILOR INTERNE · a) In cazul prevazut la litera d), la intocmirea actelor de stare rornane, ca urmare a transcrierii In registrele de stare civila rornane a certific

·.. t: ~ ,. " ' lG." . i", 0\

COMMONWEALTH OF PENNSYLVANIA O: P/, RTMENT OF HEAU f.

lh is is II) ccn ily thaLth<: ce rt ifi cate hereunto attached is a true and acc urate C llP~ ..' ( the origin.1I

record on file with the Div ision of Vital Records and that Marina O 'R eilly' lauhcw. wh ose

name is subsc r ibed thereto, was at the tim e of subscri bing the State I< <:gi-!rar for the Department

uJ' Health. for the Co mmo nwealth \ f Pennsylvania, dilly appointed anJ commissioned a, directed

b~ the Vira l Sta tis tics Law of 1953 ,

" . 1 ' i\ ,' ( , .' ) ; \ ) __ /j'\ \ , _ " , , \.... w (I ' \ I t, · ,, \ ' 0, ~

Michael WoJf Acting Secretary of Hea lth

:. ~ I C"1,:.EL '/"Ol r;:. ~C T l t G S E ='~ _ ~APY

t- !::&t ; l" e-i ~ , ~ ' :'". s.tA.~ PI":' ' ·· .r:· ~ . ~ : : ~ # .. ~l' . F J 1 " t " ~ ~ - Q-'J" t rotOi.' !. ~ ~ 1 "; ..

..., . ­

Page 14: MINISTERUL AFACERILOR INTERNE · a) In cazul prevazut la litera d), la intocmirea actelor de stare rornane, ca urmare a transcrierii In registrele de stare civila rornane a certific

I

'I 1.. -I"

WARNING' It is i ll eg al to duplicate this c op y 0 \ ph o to s ta t or p h otograp h

r, r,i '

) ~ , March 18, 2013

, SM~~""'"'!'~m-ri~~~~::;:o;;r1'l"==~=~~=~~=;-----j

.- - ­I

1"--""::: "~--~ r .::;;:;:: ~::.~~.:~.: '.7:.7

",irl!:;::.:=~ 0 '­ '­ -. 0 ·_ .... tJ •• -4_ , _LJ _ a t .~ . __ __ A ...

1S1 ...... _ ..,.,...........-~ __ ~ ....-.. _ "--o f

. _._------~

-----­ ._•.:.~"""",,. -=.=.=.,.. ::;;~,------------

~ . _~.--_._- a-­

"__ 0 ( . 1

.-... n - ..~..... _­ .,... U ... · fA.Al •• '_....• ..

8 :::::::::::= ::::.:::::~::~ ...,..0 __ >1 .............. -...... • __ .......

"'---­ - --­.. _..- .... ,......­.,..... _..- ~ . ~--

""-,,~~._.-.. ~,_. _........... _""'..._-­... ........ ..... .

~ =:=g;;;::::=----=:~::.~::..====_.l . ___Ja t.o-... .•_ _ .._._-......_ ~ _ o---.·c.... ......... _._ .. __... ­ _ ..-_._.--..-. --.. __ ,.._ ...-... ,__.. ._ ~...::':"..'::::~~~ ~ -1 ' ~; ~': ;, :'~" -:: _::":~ '=~ J' _. __-'_"

1~....::A;,~~·~o':' ..~ ~~~':;; ~.~ .•~" o-» &3 .lI. ""'AI'" PA l~-;=;: ';,;,;:;-~:;,":,>"""'-···<a.;'L;q.r I" ;;........ :-~ p••-::*=. 1 ""-;;'-'-I-/~'"

, '-.-.

... ...

Page 15: MINISTERUL AFACERILOR INTERNE · a) In cazul prevazut la litera d), la intocmirea actelor de stare rornane, ca urmare a transcrierii In registrele de stare civila rornane a certific

APOST IL LE

'n ux I' I.:BUC J)O C UME i"T

::;. has been signed by .J( SElnl Y CAMPOSEO

C EHTI FI ED

(l. Oil March 01 , 2U11

7. h\' DEN iSE W. M EIUU 1.1., SL<:n.:lar:- ~I r the SLaLe of Cou nccu vut

s. Number : 201 1-,211 ')

9. Sea l :

ID, Sign.uurc

Sccrctury or the S Lal~'

Page 16: MINISTERUL AFACERILOR INTERNE · a) In cazul prevazut la litera d), la intocmirea actelor de stare rornane, ca urmare a transcrierii In registrele de stare civila rornane a certific

I •

c e-q n Flc:. n , c r C_ T!'f .. ... yw."

4 •- .

1 cert if I I Ih is is :s [rue ('()P~' or t h ~' certifica te received for r ec rd , excep : for sucb in~" r m t iM; wh ich i nun-d is d O\ :1b lr: ll ~ lu,\ .

An

Dated:

o ').!.~ I/. a ~~ I n }~ . '- LC rl" p t l (, ~ 1 Ir 'lf ( ,\ : ~ ..i " : ;\.11., 11 " ,

OfC 1 3 7. 01 0

Page 17: MINISTERUL AFACERILOR INTERNE · a) In cazul prevazut la litera d), la intocmirea actelor de stare rornane, ca urmare a transcrierii In registrele de stare civila rornane a certific

Apostille (C IJI /I 'en rifJ1/ de fa I lave du S-Octobre 11j1iI-i . . , ~

1. Tara: Staiclc Unite ale Americii

Prezenrul act oficial

2. A fost sernnat de JOSEPH V. CAMPOSEO

3. in calitate de Ofitcr Evitlcntn Popul:.ltiei

4 , in statu l Connecticut incepand cu data de 7 iunuarie ~002 pentru perioada nedeterrninata

Arcstat

5. la HARTFORD, Connecticut 6. La 04 mnrtil' 2011

7. de catre DENISE W. MERRfLL, SecretaI' a] Statutui Connc<':licl,lJ.

8. Nr. 2011-2119

9. Sigiliul: Sigiliul Statului Connecticut

10. Sernnatura: Semnatura indescifra la

Sccrerar de at

Subscrnnata HARSAK CruSTlNA BIANCA traduculor 3.U LOrizat de Ministerul Justitiei cu autorizatia nr. 23390/2000. ccrtific cxnctiratca traducerii ell tcxtul ins..:ri .ului til original in Jin ba engleza care mi-. 1'051prer.enlUI.

Page 18: MINISTERUL AFACERILOR INTERNE · a) In cazul prevazut la litera d), la intocmirea actelor de stare rornane, ca urmare a transcrierii In registrele de stare civila rornane a certific

-. -I

i itA( ,

I

XJ L' IL:

I l m ,\ n CI. SI I.LI! l.:J5 pm

- ----- --­I

[>,\ f DE ' I,SI ' I f I ' I?I U OIO ;'Ii....

I. I)!\fA 1~ .11.2Il1 1/

- - - - - - - ­

' -, l .4. tT

11r,u..&1

lJ l. l\ l t\ i'I

C ER'J (FICA'! DE OE

...n ° I

5 \" ,u ...,

. " RE CT

I:? ., " It, ~OA PO J f' t:RSO.\;.; f:

, F.~KA CAS " I

1

; 4. u· l -) -------,...I I-~-l l'-· C.c.· :-\ D-,-t-\l \, f( f. \ j~ Iii -; ~ I I l " Il. L" LJ,'\rj 17. NI)MCl.h SO l 1£11:--' \,1 ..\1 '1 -060JO 1:-;AR.\ 1t\T..\ I I.. . I~ H l rll l l XX /.... ECllNOSCIJ'I )

NL' CA r onrr III M~mI. E TAT..\Ll!1 ~'IE I .£ 1 ~ 1 r: 1 12lJ NU- "'- I-F.­' \I- I­' (­'ll-' ­' [ () l ~ , ] 1. Rd:lliJ ln ~ rn u lurul.J . ~nH \IlIST:\F.\ , 11\ A I'd /: 11I­, C.·\ S.\TORIEI. GIlI ULlI,I' .,,"n:·, ;:k(un.:tul:

_ _ _ _ __ . I ~1I : (',,,n£R ' lET 0 [so u,

i: ''' 0 1:' ." O- COR ' ·I "';I)f"r. _ ' u~ ' ~ I )f- r II ~ \I ' J.l · L '4 n · 2 .i. ~~ 1 \ (f l r.1 ,If~ l ll I ~:: "ASw<"c r o:'> ~I_ 'UOOL [,TOW~. I.' R· t :o.. sr rrvr, " "'~ Ht:.' TI U M[\I0RI H

5: U >L.... ,,\. : PIT U l.,T H :>PH" L

j .l. ~I \1' ." 1t. R..\ 1:\1 \

1 - - _ ._ - -

, ' :? ll ~) SI Il !n!' L'Ii\lORM :'\T .\IU:: .

,19. NUMEI.E CIMITIIWL I: L I ~I I T I R M

) 1) rx :,\T I,\ (OIl,A SLJ I .. ·IAT 'L l : [NFI !';!.1l •

, 32. ,\ FOSTTRUPI)I.I.\l!JAL~AMi\T? xu

Certitic faprul C~I ceast este o copie n lidcla a cCltiri t:IIlUll i primit SPI'C. inregistrare. Arcsiur: Joseph V Camposec

D:uc: t3 dcceruhrie ~ n I0 Ianchestcr. CT