Philippines“? ™ OFFICE OF THE CIVIL REGISTRAR GENERAL * CERTIFICATE OF LIVE BIRTH Registry No. Provit en eas see | «| 20a aay, ‘Municipal Form No, (Revised August 2010) Republic of the City/Municipality City of Batac Fis ‘waaay Tat VIEN CAELI GOROSPE ALETA. IC | 2. SEX (Male/Female) ‘3. DATE OF (Day) (Month) ‘vane, IH FEMALE BRI 20 FEBRUARY, 2023. ve of Weep ETETOVGAT aa Prone 1 |4 PLACE OF Fite Re. St Berangay) yee oan L|_®ST Mariano Marcos Memorial Hospital & Medical Center, Bray. 6 San Julian, Batae City, Ik D | S=.1¥PE oF BiRTH Snr HUCEPLE BIRTH, CHILD WAS [5c.BIRTH ORDER (ovr «(re m2 [6, WEIGHT AT BIRTH ‘Shnie,Twin, Tre, ee) (Fast Second, Ths, ete) pr tern al Single ey First 3125 grams 7 MAIDEN Fray Tae) To NAME IM GERALDINE ADAON = GOROSPE lo |® cmmzensti {9 RELIGIONRELIGIOUS SECT IT Filipino Pentecost zest |p| Oa Tt ot TOE ns fet it [106 Ko on bom 17, OCCUPATION RAGE we ne Chen bo sv eg eg bh | ve I we now Gnd ih emote 8) E 1 lee 0 Job Order Worker __ IR | 13. RESIDENCE — (House No., St, Barangay) {City/Municipality) (Province) (Country) Brgy. Nagsurot Burgos Ilocos Norte Philippines F | wae Far Wee) Cast ie ARJAY PASION a ALETA, a 7 | 15 CmTZENSHIP 16. RELIGIONELIGIOUS SECT __[17. OCCUPATION TEAC ae ne ofS bem Cong 25 H Filipino Roman Catholic Civil Engineer ae 4 E |79: RESIDENCE Giouse No, St, Barangay) _—_—(ClyMnicpaty) Proven) (Coury) R Brgy. Nagsurot Burgos Ilocos Norte___ Philippines ___| MARRIAGE OF PARENTS if not married, sccomplsh Afdavt of Acknowiedgement/Admission of Patemty at the back) lao DATE (Worih) (Day) (Year) —_[206. PLACE _(Giyhtuncipaiy) (Province) (County) 82021 ___Burgos Ilocos Norte Philippines _ 4 Hot (Tractonal Birth Atlondant) 5 others (Specy) 3 |v 1 Physician 2 Nurse 3 Miwife Ip4b. CERTIFICATION OF ATTENDANT AT BIRTH (Physicon, Nurse, Nidwifo, Traditional Birth Altendanv/Hio, ete) hereby cert that | atlended the birth of the chid who was bom ave at0:23:48 AMam/pm on the date of birth specified above foe 6 hase Mopaianc ae IName in Prnt _JAYMEE CARRASCO.CKTUS) y. MD [Tite or Position _Modical Officer Date. February 21, 2023, a ae 2 CERTIFICATION OF INFORMANT eee | hereby certify that all information supplied are true and correct to my own knowledge and belief Relationship to the ChifGrandmother __ Title or Position _ Supervising Administrative Officer ___ [Address __Brey. Nagsurot, Burgos, Ilocos Norte Date _ — February 2, 2023 a ees Beatle aoe eee Spath ee a einai JOYCE t. BARTIDO ene a Ge LORLYN FUQRDELIZ P. ULIT nes Position ASSISTANT REGISTRATION OFFICER ee eee ~ ciTy< REGISTRAR: re 21 FEBRUARY 2023 llarsy 22 FEBRUARY 2023. z REMARKSIANNOTATIONS (For LCRO/OCRG Use Only) ‘TO BE FILLED-UP AT THE OFFICE OF THE CIVIL REGISTRAR ie ey 2 eg kg. »