Attestation of the Registration of Births
Model 5 M
1 CANADA PROVINCE OF QUÉBEC District of Montréal No.:
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SUPERIOR COURT Family Division (Divorce)
Micheline Tremblay JOINT APPLICANT AND Roger Gagnon JOINT APPLICANT
ATTESTATION IN RESPECT OF THE REGISTRATION OF BIRTHS Neither party’s birth was registered in Québec.
(Do not fill out sections 1 and 2. Enter the date and sign on page 2.)
The wife’s birth was not registered in Québec.
(Fill out section 2 only. Enter the date and sign on page 2.)
The husband’s birth was not registered in Québec.
(Fill out section 1 only. Enter the date and sign on page 2.)
I hereby declare that: 1. The wife (or husband) was born on in (date of birth)
(place of birth)
and was baptized or the birth was registered on at (date of baptism or civil registration)
(parish and municipality, in case of baptism, or municipality, in case of civil registration)
She (or he) is the daughter (or son) of and OR (Form to be used where the act of birth was issued by the Registrar of Civil Status) The wife (or husband) is years of age and the registration number of her (or his) act of birth in the register of civil status is ;
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2. The husband (or wife) was born on in (date of birth)
(place of birth)
and was baptized or the birth was registered on at (date of baptism or civil registration)
(parish and municipality, in case of baptism, or municipality, in case of civil registration)
He (or she) is the son (or daughter) of and OR (Form to be used where the act of birth was issued by the Registrar of Civil Status) The husband (or wife) is years of age and the registration number of his (or her) act of birth in the register of civil status is .
The parties have signed (place and date) (signature) Joint Applicant (signature) Joint Applicant
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