Ofthe UnitedStates, r.
in Order to form moreperfect Union,
establish justice, insure domestic Tranquility,
providefor the common defence,
promote thegeneral [fiefare, andsecure
the Blessin ofLiberty to of elves and
r o ordain andestablish this
die UnitedStatesolilmetiii
LAIRE / FIRMA DEL TITULAR
SIGNATURE OF BEARER / SIGNATURE DU TITU
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Type /Type / Tipo Code /Code / C. Passport No. / No. du Passeport / No. de Pasaporte
Surname / Nom /Apellidos
SHULIAK 4**.SiO,
Given Names / Prenoms / Noriilark-
KARYNA
Nationality / Nationalite / Nacionalidad •
UNITED STATES OF AMERICA
Date of bith/bate de naissance / Fecha de nacirriecto
Sex / Sexe / Sexo
Prase of birth / Lieu e naissance / Lugar de nacimiento
F
Authority / Autorite ! Autor dad
e de delivrance / Fecha de expedicion
• United-States
Date of expiration / Date d'expiration / Fecha de caducidad Department of State
Endorsements / Mentions Speciales / Anotaciones
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