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Consulate General
of Lebanon
New York
Child's full name:__________________________________________________________
Date & Place of
Birth:______________________________________________________
Male or
Female:_________________________________________________________
Father's name:___________________________________________________________
Father's date & place of
birth_______________________________________________
Father's place &
number of registry in Lebanon(District & Caza):__________________
Father's religion:______________________________________________________
Mother's name:_______________________________________________________
Mother's date & place of
birth___________________________________________
Mother's place & number
of registry in Lebanon(District & Caza):______________
Mother's
religion:______________________________________________________
Applicant's address, telephone number in the U.S.A.:_______________________
Date and Signature of applying:______________________________________