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102(Revisedr Jano Lg45)

REPUBJ,IC OF ?HE PHI],TPPTNES PASAY C]TY CERTIFICATN OF BINTH

Philippines

City of
Barrio of Name of chila:
Date

Province of

PLACE O}' B]RTH ....i r.ir-;

No"

Register No.

t-TJ \.j.'*'-r-r-.,i

*;C

r Municipality of S treet
':-.+,=-.,.. .--

':-:r.-,',j -

ff child is not yet

named

supplemenTffilfi as directed
: Legitirnate
Twin
tr^i n] o*

of Birth

Sex of uhi Ld

Nationality

i'lo. in
nrAa+. LL

: I'.1;-: ;r,,u , tr,. ,

births
Month

p1ura1

be answe eed in event of

Day Yeai

at lasl Em;;?---Birthplace ;1,:.-."- F L-'!r'il S+o+,,R-Civil- S t"t, n

Ase
: ::-

FATHER Full Name ..*,+r:l Residence ,, i.-i_ i,:..:l S Clti"enship-:-Ii:c

*--* 4--!.-'

I'IOTHER
.

:-

rurr l\arne ^: Residence f--: f

.j!.:,
= !

,r

. r ..: *
_r_ -_--*

?il Age
*-

t::":lii at
o^ov

.ir '*.

inthn'l e--lJ*qv
Oc

tast TGthdt;
;Aj-ii^
vlr ua

uceupatron
Number T-liE=Ieti

jJ.i ii.

..

cupat ion

of rn11$t'n6ffi6!t tr'is :' 'hilflre&-bsr4 tc E

TE OF
ATTEN

motr"or

lY ;'tff5.F?*-o

living

?_
OF
THE

-;-p

, r--;

CERTI

iG PHYSICI
L

OR MIDWTFE

OR

I"'AT'HER OR },IOTI{ERT'

) father of ( Wtren there lras no attendine ) at ltas attending date above stated ) ,*"ul :n"re \phy-q:-cian or midwife, then the) (father or mother shoul_d naie -) _ (ttr:.s return. A stil1 born -/ ..- i ( L^! \ en]..Ld t-s one that _^._r-neither ) (breathes nor shour: other evide) (nee of life after birth. )(
Given name added from a supplemental repo"t_19__

t -l save bilth to (_..arn the -"^.,--_ ' f'

*C-'-' chif Lva) 1 rn:-s ur!ar\4 d rvas (bornffi

- jI ' r;

'-

'- :

;':

j: I"i. on the

, ,

i.j4 : )
-;!i--.-.r-

-.

tvrtiuqLL{ag./

,,**t*,;,_

Local Civit Fegistrar

FII,E

Registrar within ]o days fronr the date of birth"

ffi$l

"ot

-7 !OCa-L t,fVf-l riilL,lure to do so is punishable by a lespp'glrqnr# @ing i$rarrnfbrsrs&a$F{gaeayool-.[;; . fl57 socs. 5 anc, r?. "1 -i'ir
:.1.,1

,'

,:. D$i13C

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