” ‘oricipal Form No. 102 ¢ — (Revised Augus 2016) of the Philippine OFFICE OF fle CiVIL REGISTRAR GENERAL CERTIFICATE OF LIVE BIRTH ry No. Province ZAMBOANGA SIBUGAY | City/Municipality ROSELLER LIM 4, NAME RIZA DIVINAGRACIA PABUTAWAN oz 3. oATEOE co peuae om | a ee as Ha nuceor I Bar L [AT HOME, SIAWANG, ROSELLER LM ZAMBOANGA SIBUGAY bs re or ori SNE MITIPLEBRTH.CHLDWAS SBRTHORDER S WESGHTATBIRTH SINGLE NoT eC Fi 2722 ere 7 Maen | a ERMA | PALING INAGRACIA M a cancer | ¢ REUGONRELGOUSSECT t FILIPINO cATHOLIC Fy 100 ratneberat "0b Ne ot ce ace 1 0¢cUPETON 12 fot ane mie fo See oe Tr anieleen: Ria nescence SIAWANG, ROSELLER LM PHILIPPINES. 4 aM a RIZALINO BACATAN | PABUTAWAN 9 scams 12 REUGIONRE {7 OCCUPATION | te see te te te ii FILIPINO raRMER : E 19, RESIDENCE 1 f SIAWANG, | ROSELLER LIM oe PHILIPPINES MARRIAGE OF PARENTS recmee exon mandttoniresnane ty oe 200 O4FE ACE NOT MARRIED | NoT APPLICABLE | 2 ATTENOANT | rryeion 2 Nm 2A | Yon Aten) | § Ober (Sect) 2b CERTIFICATION OF ATTENDANT AT BIRTH { Moser cy at anended the ith ofthe id who was bom ake at 10:00 PM. efvpm on he dete of Din secfed above (DECEASED ) . Signature ‘Agaress NOT API E Name in Pint ATING CANETE: | “Tite of Postion HILOT | pate NOT APPLICABLE 22.CERTEACATIONOF INFORMANT zapreparensy | hry ct a a oman sped we nd comrectoy om sngedge and bt sone Plane gio wget So comers icon Name in Pent Retatonshiptothe Chid: MOTHER Tite or Poston CLER ‘sires KATIPUNAN, ROSELLER T. LIM, 2SF we MARCH 25, 2019 De MARCH 25, 2018 24 RECENEDBY 25 REGISTERED AT THE OFFICE OF THE CIMIL REGISTRAR, Signature Signature Nome in Print ANICETA B. MEDALLA ‘ite of Poston MUNIGIPAL CIVIL REGISTRAR Date ame in Print Te or Pesiion Date DELAYED REGISTRATION,