M i r i E m b r y o D i s t r i b u t i o n
Declaration of Fatherhood
Name :Miron Family Name: Mualem
Passport number:31869209 Marital Status: Single
Gender:Male Nationality:Israeli
Address: Negba 32
Tel: 7392324
Profession: Time whriter
Visual or verbal comments:
Once I signed this form, this creation is mine.
Date: 08/4/98