AUTORIZAÇÃO PARA CONCESSÃO DE PASSAPORTE PARA …



-342900000CONSULATE GENERAL OF BRAZIL IN HOUSTONVisa Department1233 West Loop South, Park Tower North suite #1150Houston, Texas, 77027visa.houston@.brAUTHORIZATION FOR ISSUANCE OF BRAZILIAN VISA FOR MINORAUTORIZACI?N PARA LA EMISI?N DE VISA PARA MENORESWe authorize the issuance of a Brazilian Visa for the following minorSe autoriza la emisión de una Visa de Brasil para el/la siguiente menor1 - MINOR IDENTIFICATION IDENTIFICACI?N DEL/ DE LA MENORFull Name Nombre y apellidos FORMTEXT ?????Place Of Birth (City, State, Country)Lugar de Nacimiento (Ciudad, Estado, País)Date of Birth Fecha De NacimientoDay DíaMonth MesYear A?o FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Passport InformationIssued by (Country and Issuing Office)Issued on Fecha de EmisiónNumber NúmeroEXPEDIDO POR (País y la Autoridad Expedidora)Day DíaMonth MesYear A?o FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2 – PARENTS INFORMATION INFORMACI?N DE LOS PADRESFather’s Full Name Nombre completo del padreMother’s Full Name Nombre completo de la Madre FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????□Passport Pasaporte /□Driver’s License Licencia de conducir □Passport Pasaporte /□Driver’s License Licencia de conducir Number NúmeroIssued on Fecha de EmisiónNumber NúmeroIssued on Fecha de EmisiónDay DíaMonth MesYear A?oDay DíaMonth MesYear A?o FORMTEXT ????? FORMTEXT ????? FORMTEXT ?? FORMTEXT ?? FORMTEXT ???? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?? FORMTEXT ?? FORMTEXT ????Issued by (Issuing Office) EXPEDIDO POR (Autoridad Expedidora)Country of BirthPaís de NacimientoIssued by (Issuing Office) EXPEDIDO POR (Autoridad Expedidora)Country of BirthPaís de Nacimiento FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????3 – FORMAL STATEMENT DECLARACI?N FORMALWe declare that the above information is true and accurateDeclaramos que la información anterior es verdadera y exactaPlace LocalDate FechaPlace LocalDate FechaDay DíaMonth MesYear A?oDay DíaMonth MesYear A?o FORMTEXT ????? FORMTEXT ????? FORMTEXT ?? FORMTEXT ?? FORMTEXT ???? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?? FORMTEXT ?? FORMTEXT ????Father’s Signature Firma del PadreMother’s Signature Firma de la Madre FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????4 – NOTARY’S CERTIFICATION: Parents or legal must have their signatures recognized by Notary Public before submitting a visa application to this Consulate.CERTIFICACI?N DE NOTARIO: Los padres o tutores legales deben tener su firma reconocida por el Notario Público antes de presentar una solicitud de visado de este ConsuladoNOTARY’S CERTIFICATE OF ACKNOWLEDGEMENT FOR FATHER’S SIGNATUREFOR NOTARY PUBLIC USE ONLYNOTARY’S CERTIFICATE OF ACKNOWLEDGEMENT FOR MOTHER’S SIGNATUREState of ___________________ County of _________________________________On_______/________/_________, before me personally appeared____________________________________________________,□ personally known to me -- OR –□ proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s) or the entity upon behalf of which the person(s) acted, executed the instrument. WITNESS my hand and official seal.(Notary’s signature, stamp and commission expiration)State of ___________________ County of _________________________________On_______/________/_________, before me personally appeared____________________________________________________,□ personally known to me -- OR –□ proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s) or the entity upon behalf of which the person(s) acted, executed the instrument. WITNESS my hand and official seal.(Notary’s signature, stamp and commission expiration)Note: 1) It is mandatory to add the original birth certificate or its notarized/certified copy on minor’s visa applications.2) Children of Brazilian nationals must additionally present a declaration of non-citizenship. ................
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