MAIDEN ray Waa) ee) ae NAME 5 4 [ Foner Ae aon | raves § 7. CMZENSHIP 8. RELIGION Be M * isin [ee = i 0a Toainumberst ~ |B Noofehilrenatl Te Reverenieren 11 T | eniteron Thing incing bomaliebut alse | ah tris bir renoudead: 0 Het © [i0. OCCUPATION TH. Age at the time ee - i R otter civ Housckeeper 3. yer 12 RESIDENCE (Hause Ne. sree, Barangay) Giy/Mnicgalg) _—_ Prownes) Cee ge eee : a i F | NAME ost ta - A _— emit © ty [14 mTIZENSHIP 15. RELIGION : t Betas Sonn Gathotio| LL ; E [1 OCCUPATION 17. Age athe te oe R 70 n za) 118. DATE AND PLACE GF MARRIAGE OF PARENTS er not isaried, accomish Atidavt of = Aeknomledgmen/idmisicn ofPatenity atthe Back) ? 4 ans 7s 9 198. ATTENDANT Tala faa $Physiian 3 Micuite a “Hint actions Mts) o i 305 CERTIFICATION OF BIRTH a i ‘hereby’ dent that | dnendoc ell s/n on the dia sated eb, ‘Signature ert Namein Pi SORIA "SAGES “Thi otPoeon Aa 20. INFORMANT Snare Asdardn _Sesogepes Namen Pint GREINER DTene Foiaioneptomecnid —damghile 21 PREPARED BY 22, RECEIVED AT THE OFFICE OF 4 THE CIVIL REGISTRAR soroun —~Githadunntas Yo Prenat) gapsiey —Lokadissas A Ceastatl| sana ot GIA Bt ie SRE | sure CB “Tie or Postion $8 is ‘wiser ee Date be Op 195 - ae ro = 30 2¢B/ 77 a FOR 2) Mo Oveea