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Page (Copy lor OCRG) 1 of 1, 1 Copy I firriia*4 Form No, 1o2 (harlEad January | 1993) Ii:j l: 1,.]. il'i:i- ii:i ; I I ';': ,i l, )'i :-, HEMARKS/ANNOTATTON r-ri:. ..ivletfol,lanllai .r-.r , t.: ,.[ ffegislryNO.,l, . ,ir9:lirce --::----iffitiryT--;:-:, iiw/Municipattty "T" -. 'l :l,' , ', B.IOS66 ili I i-l il'i itl bi Itl, ;li I ill :D t: l il; :NAMEL.,i', . : (Fkst):- :; i-r:)l- /.)r: .I (Middl6):. ili.ijlr:l j, i.1": ,(i-8ar)i-i,l ii'...: irt:t Jolil{r ilLOl,.;Dr:lill::.rl:li:1,.: i'liL-:(.,1:Jil:l',: BAIJL$, For OCRG USEONLYi.- -., , . . ' :' ! PopulollonRslortncofld': . I . il I ?.SET. . ii ^ 1. Malo - 2'f:omr:16 3l EAIE OFr BIBTHs, r,r({qy) , (mqq!h). rglel) :r :i r. i:r28::5eptenben':1996 ilo trl+ 40 U '09 , m 6l a TO,BE.FILLEO UP ATTHE OFFICE OF THE CIVII. .' . REGTSIRAR .' ... .r i . - : 4l ihia ftrr,-El .8 I t, ptloE OF (NameorHosfrreirj/cn,i1i7rn3i1rqini . tcrty71ir,1li14,1lory1 ,,:'fqrq;i,11*i, , BIRTH. House No., Streo...Batangay) - , .: ' , "'^"'. n"5;;ii*i" Gtlid("ti Mqkaii crtv :': ' 5a. qPE OF BIRTH . '" 1 Slnglo -* 2,Twir 0 Triplet, 6to, u. iir uullrru BtnrH, cHiLD'WAs - 1 first .. -2 Socond _* 3- Ohors, SPsc;,Y - c' BIBTH ORDEB (llve bldhe 6nq lolal doatha , lncluding thls dallvc.Y) I _ (ttrst, eooon.l, thlrd,slc,) . d, WEiGHT AT B|RTH ' ]o9o .- srars M ,o :T rH iE, iF ;lr i!l 6. MAIDEN (Flrt) ' ' (Mtddle) '(LaB0 NAME MA. JUi,uitA BRU1ASI iiALL4 iLlGloN ,oatirotlc 9€1., Toulnumborol , ahlldrsnbqra 1 . ellEr - b,, Ne,olchlldrun.stlll ,llv,hglndudlrlgr 1 lhlBblrih: -}i-* c" No,olchlldion boro allve but O . 6ra row doedi ,*-* 10, occuPATloN :,----'",'-" cashl,-,r, i: : 1!. : ao.€ st lhd rlme i ' olintr btrttrl 22 .i . l . r .- ygare E' jEEEFF9Fdtt.l'#a'ie't'intll$fl Lr...p"",Y#*#'Jr*(Provrrtca) 'F, iA I? iii F; ;H t3, NAME iFrrtrr) UIqKN0'Y'II\I 7g I"?IE. 17: r l::AfrE ei lh6 iiide , ,r , ,. ,otitrigoirth: ,N/A. .t. .. ''I 1..* - --Yoals "r:ir'l: : l,-_... f r:; ; ii-ii:: : i-l if: l ii il,r '', , 1! ii oere AND Pt-AcE oF MAFIIAGE oF PAnENrs' (11 na r.,4ea, i;mfiisn ntioavit ot a;- ;;;;;,;0n..",1*.,.', notp"i"iniiv"itt.tuit.i, - " i, ', .,t; ,r'Iqt appliqable ,'I ,l ,],, ,,'r l':,, ,,:, .'i. .' M;- ,---lf .Physician . -2 Nurse .. :' ' -3 Mldwifs , -4 Hilot (T raditional Mdwit€ ) - s Others (speclly) . }b..CERTIFrcATION OF BIRTI-] " I 1=, , "', , j,nill;i';"ii ",,1*.0 1", birn or u,e &irl wiq was uom stt e at-lall o cto"t 1/pln on ths datg slal€d sbow' .- t'l!,"-"":--;--=4a_; t- : ospital i,tg i,,akatt 3qa:ture --==-=43ig6{g6,s1s! t$defto, i,i . D #fpaffi t rh6inPrint-€+€+€.+#+€+tqtl:- .# + 10"'INFORMANT' ' i -- '.., ri:r.l '' ..'r' ' -.r. r"., : DnaiurEr--;Tte;:JLrte-tlf-ndlla MffiiLffi :. .1! il : .al. , ,sl -,'N; - r-rt ', sl 86.A7 93 E Ei., 14ffit- *t++'r loo99g 94 m I RelarionshiplolhB child .---, : ucl,ooer z, t>.yo Da{.G --_ :I'.:21 PREPARED BY ' ' ' ^ /')/ /,lfr&- . signaturo ----ffifu1-l.kreroc Nameinprinr / f ibd. dec _-.Jeick Title or Positiofl €€+€b++--+r€8- . . Oate-..==-- I o29r3+tilo6EDR{c465 I BEST POSSIBLE IMAGE sEL l ilr il ilililil tillt Iil il ilrll il il]uililt iililfl lll T00602973006004650221 200800 1 Y F $C* 3I r'?! S BReN 07602-A9BSU0'1 -2 Administrator and Civil Registrar General National Statistics Office

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  • Page(Copy lor OCRG)

    1 of 1, 1 CopyI

    firriia*4 Form No, 1o2(harlEad January | 1993)Ii:j l: 1,.].il'i:i- ii:i ;I I

    ';': ,il, )'i :-,

    HEMARKS/ANNOTATTON

    r-ri:. ..ivletfol,lanllai .r-.r , t.: ,.[ ffegislryNO.,l, .

    ,ir9:lirce --::----iffitiryT--;:-:,iiw/Municipattty "T"

    -.

    'l :l,' , ', B.IOS66iliI i-lil'iitl

    biItl,;li Iill

    :Dt:l

    il; :NAMEL.,i', . : (Fkst):- :; i-r:)l- /.)r: .I (Middl6):. ili.ijlr:l j, i.1": ,(i-8ar)i-i,lii'...: irt:t Jolil{r ilLOl,.;Dr:lill::.rl:li:1,.: i'liL-:(.,1:Jil:l',: BAIJL$,

    For OCRG USEONLYi.- -., , . . ' :' !PopulollonRslortncofld': . I . il

    I?.SET. .ii ^ 1. Malo

    -

    2'f:omr:163l EAIE OFr BIBTHs, r,r({qy) , (mqq!h). rglel)

    :r :i r. i:r28::5eptenben':1996

    ilo trl+40

    U'09 ,

    m

    6l

    a

    TO,BE.FILLEO UP ATTHEOFFICE OF THE CIVII. .' .REGTSIRAR .' ....r i . - :4l

    ihia ftrr,-El

    .8I

    t, ptloE OF (NameorHosfrreirj/cn,i1i7rn3i1rqini . tcrty71ir,1li14,1lory1 ,,:'fqrq;i,11*i,, BIRTH. House No., Streo...Batangay) - , .: ', "'^"'. n"5;;ii*i" Gtlid("ti Mqkaii crtv :': '

    5a. qPE OF BIRTH.

    '" 1 Slnglo -*

    2,Twir0 Triplet, 6to,

    u. iir uullrru BtnrH, cHiLD'WAs

    -

    1 first .. -2 Socond

    _* 3- Ohors, SPsc;,Y

    -

    c' BIBTH ORDEB (llve bldhe 6nq lolal doatha, lncluding thls dallvc.Y)I

    _

    (ttrst, eooon.l, thlrd,slc,) .d, WEiGHT AT B|RTH

    ' ]o9o .- srars

    M

    ,o:TrHiE,

    iF;lri!l

    6. MAIDEN (Flrt) ' ' (Mtddle) '(LaB0NAME MA. JUi,uitA BRU1ASI iiALL4iLlGloN ,oatirotlc

    91., Toulnumborol, ahlldrsnbqra 1. ellEr

    -

    b,, Ne,olchlldrun.stlll,llv,hglndudlrlgr 1

    lhlBblrih: -}i-*

    c" No,olchlldionboro allve but O

    . 6ra row doedi ,*-*

    10, occuPATloN:,----'",'-" cashl,-,r, i: :1!. : ao. st lhd rlme

    i ' olintr btrttrl 22

    .i . l . r .- ygare

    E' jEEEFF9Fdtt.l'#a'ie't'intll$fl Lr...p"",Y#*#'Jr*(Provrrtca)

    'F,iAI?iiiF;;H

    t3, NAME iFrrtrr)UIqKN0'Y'II\I

    7g

    I"?IE.

    17: r l::AfrE ei lh6 iiide ,,r , ,. ,otitrigoirth: ,N/A. .t. ..

    ''I 1..* - --Yoals"r:ir'l: : l,-_...

    f r:; ;ii-ii:: :i-l if: lii il,r'', , 1!

    ii oere AND Pt-AcE oF MAFIIAGE oF PAnENrs' (11 na r.,4ea, i;mfiisn ntioavit ota;- ;;;;;,;0n..",1*.,.', notp"i"iniiv"itt.tuit.i,

    - " i, ',

    .,t; ,r'Iqt appliqable ,'I ,l ,],, ,,'r l':,, ,,:, .'i. .'M;-,---lf .Physician .

    -2

    Nurse .. :' '

    -3

    Mldwifs,

    -4

    Hilot (T raditional Mdwit ) -

    s Others (speclly) .}b..CERTIFrcATION OF BIRTI-] " I1=, ,

    "', ,

    j,nill;i';"ii ",,1*.0

    1", birn or u,e &irl wiq was uom stt e at-lall o cto"t1/pln on ths datg slald sbow'

    .-t'l!,"-"":--;--=4a_; t- : ospital i,tg i,,akatt3qa:ture --==-=43ig6{g6,s1s! t$defto, i,i . D #fpaffi trh6inPrint-++.+#++tqtl:- .#+10"'INFORMANT' ' i -- '.., ri:r.l '' ..'r' ' -.r. r"., :

    DnaiurEr--;Tte;:JLrte-tlf-ndlla MffiiLffi

    :. .1!il

    : .al., ,sl

    -,'N;- r-rt

    ', sl

    86.A7

    93

    E

    Ei.,

    14ffit-*t++'rloo99g94

    m

    I RelarionshiplolhB child .---,: ucl,ooer z, t>.yo

    Da{.G --_

    :I'.:21 PREPARED BY ' ' '

    ^ /')//,lfr&-. signaturo

    ----ffifu1-l.krerocNameinprinr / f ibd. dec _-.JeickTitle or Positiofl +b++--+r8-

    . . Oate-..==--

    I o29r3+tilo6EDR{c465I

    BEST POSSIBLE IMAGEsEL l

    ilr il ilililil tillt Iil il ilrll il il]uililt iililfl lllT00602973006004650221 200800 1

    Y F $C* 3I r'?! S

    BReN07602-A9BSU0'1 -2

    Administrator and Civil Registrar GeneralNational Statistics Office