M i r i E m b r y o Di s t r i b u t i o n
Adoption Form
Given Name: Adi Family Name: Ophir
Passport Number: 50908334 Marital Status: Divorced
Gender: M Nationality: Israeli
Address: 14 Lincoln St. Tel Aviv
Telephone/Fax: 03 5636831
Profession: Philosophy teacher
Name of the new born child: Mirbryo
Visual or verbal comments:
Today, 11.11.98, is my legal son Nimrod’s ninth birthday. I hereby declare that I am willing to adopt Mirbryo and add him to the bosom of my divided family and its multitude of children.
Date: 11.11.98
