AUTHORIZATION LETTER

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Date

PHILIPPINE STATISTICS AUTHORITY

TUGUEGARAO CITY, CAGAYAN

THRU: THE CITY CIVIL REGISTRAR

TABUK CITY, KALINGA

MADAM:

I HERE BY AYTHORIZE ________________________ TO REQUEST (__) PSA COPY

NO. OF COPY

OR (__) LOCAL COPY OF MY/ THE

NO. OF COPY

( ) BIRTH CERTIFICATE ( ) CERTIFICATE OF NO MARRIAGE RECORD (cenomar)

( ) ADVISORY ON MARRIAGE

Name of Child: _________________________

Date of Birth: __________________________
Place of Birth: __________________________
Name of father: _________________________
Maiden Name of Mother: _________________

( ) CERTIFICATE OF MARRIAGE ( ) CERTIFICATE OF DEATH

Name of husband; _______________ Name of deceased ___________

Name of Wife: __________________ Date of Death: ______________
Date of marriage: ________________ Place of Death; ______________
Place of marriage: _______________

ATTACHED IS MY VALID ID FOR IDENTIFICATION PURPOSES.

PURPOSES: _______________
TRULY YOURS,

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RELEASING OFFICER:

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