Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
RODRIGUEZ RODRIGUEZ
(a)__________________________________________________________________________________
Legal Family/Last/Surname(s)
ZURLEY MARIANA
___________________________________________________________________________________
Legal Given/First/Middle Name(s)
09/19/2000
(b)__________________________________________________________________________________
Date of Birth
(c) Primary identification document of Performer must be government issued photo ID such as
passport, driver’s license, motor vehicle department ID, or military ID (each should be described,
including the ID number):
ID
Form of Identification:_________________________________________________________________
REPUBLIC OF VENEZUELA
Issuing Authority:_____________________________________________________________________
27891220
ID#:_________________________________________________________________________________
(e) All other names ever used (including previous legal names, stage names, Web handles, maiden or
married names, aliases, professional names and nicknames):
ACE_RIVERS
(1)________________________________________ (a)______________________________________
Stage Name for this Production All other names
(2)________________________________________ (b)_____________________________________
Maiden Name if Applicable All other names
(3)________________________________________ (c)______________________________________
Previous Legal name, if applicable All other names
SWORN STATEMENT: “UNDER 28 U.S.C. § 1746 AND THE PENALTIES OF PERJURY UNDER THE
LAWS OF THE UNITED STATES, I SWEAR THAT ALL INFORMATION I PROVIDED IN THIS
DOCUMENT IS TRUE AND CORRECT AND THAT EACH OF THE IDENTIFICATION DOCUMENTS
WHICH I HAVE PROVIDED ARE TRUE COPIES AND HAVE NOT BEEN FORGED OR ALTERED.”