Page 1 of 2, 1 Copy

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No 102 ffo b. rcmmp{ishsal ia qurdruplicata,

I 393)

Republic of rh€ Philippines

OFFICE OF THE CIVIL fiEGISTRAR GENERAL
CERTIFICATE OF LIVE BIRTH
(aiil oJl coFpldtoly. lsurilsly and U$ ink or typHrltor,
Pla(6 X belor! tha 2, 5b and

Province Itqevs Bo(lr RegistryNo.

CitylMunicipaiity .[IlaBA
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2w9 - 7o'l
1. NAME {Fnst) {Middlc) (tasl)
n /,n'i4rlltl t\rrr.r, nErtt
2. SEX 3. DATE OF BIflTH {dry} {mon$, &red
1 Ma,r --*ll- e rqndt tro ofi, 200e
c 4. -*
PLACE OF (Nm6olHospital/Clinic/lnctituiion/ (Ci8/lvturlicipaliM (Prcvlncs)
H BIBIH Houso No., Slr€et, 8e(angay)
I $tor Touacr Attega, f[6ta
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5a. fYPE OF BIRTH b. IF MULIIPLE BIRTH, CHILD WAS o
o X 1Sn0le _2lwin F{d Sscoad
,- -_. 3 --1
etc.
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C. BIRfH ORDER itiw birlhs.ndl6rsl drarhs d, VYEIGHI-2AT BIRTH
lra ('",'i"l::ffii;::illi"r 5Ui crr*
6. MAIDEN (Firs$ (Mdd16l (L&sl)
NAME
'r'erega 3
tl
7, oTtzENsHrp 8.
M
o 94. Toidlnrmb€rol tJ. C No.orchildron
T
H
chlldrcn born
alivs: , livlng iddudiog
thiE birth. --
r
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born.liv. but
arunowdrtd; U Ei
,:+
E 10, OCCUPATION ,1
R
Iio )E8Is
12. BESIDENCE {Houss No., Slroe1, Batengayi lcilyr'Municip6iity) {Pravtn6.)
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2
13. t{AtllE ifi!s:l {[ii{, ctsi ILast]
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A 1f1a'l ^ tT xr r
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CITIZENSHIP I5. REUGION
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E
16. OCCUPATION 17, Aso at tho ilrnr
ol this birth:
R !€a{B
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18 DA.TE AND PLACE OF MARRIAGE OF PAAENT$ 0 Dot rnNda(, idmfllin maaot ot
Ac|(qoTjledgmen! rAdilission nf Falirnity al th. back,)

llarolr 21. a
19a. AITENDANT .)
.2 llidwif. +
-.-. --.1
Phyrician Nurse _3
--;E-,4 Hilotflraditional $dwile) {Spaciry)

lgb CEHT]FICATION OF
I hereoy e*ily fial I attend€d E lvs al oUodr
e- 1Fq.^ tne dalE sEtgd above- '

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t,a-e i
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20. lr.tF3Rr..{ANr

Signaturo 9frq66f qmres, &11rgc,- il. lI .

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I'larne In

RElation$hip lo tlrE
r'sadfathe r llats -ire?:4q
2.l PBEPAREO BY 22. RECEIVED ATTHE OFFICE OF
THE CIVIL BEGISTRAR

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BEST POSSIBLE IMAGE

07346-H5- 1 38H LC-o0341 -8t001
04901 -802VA04-1
BReN ru64,v
CLAIRE DENNIS S. MAPA, Ph. D,
National Statistician and Civil Regiskar General
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3807346 1 3 84434 1 021 1 2A20001
I ill Documentary
Stamp Tax Paid
Philippine Statistics Au$rority
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