‘Municipal Form No. 80 (Form No. 2) (Revised January 1993) "The Civil Registrar © Registry No Date of Receipt Date of Issuance of Marriage License APPLICATION FOR MARRIAGE LICENSE The Civil Registrar QUEZON CITY. ‘have-all the necessary qualifications and-none of the legal, disqualification: fo contract the said marriage ‘and that the following data dre ‘rue and correct to.the bebe of my knowledge and inf ‘ OF ‘ei ‘ice “chyittuniclpainy of - QUEZON CITY" > CiyiMunicnay °F MFR EMAIL — Province of HERO MAMTA Province: of. é OF Sit/Madimy STRAR OFF DF ‘Sir/Madam: ' 1 api fe'a itn oot ndrriage with ‘May 1 ppl ford license to Contract marriage with HEGISTRAR OFM Grud ts tnd to this ‘aifec, being duly sworn; Ehereby depose-and say that F\- }|\ affect being duly aware. U hereby depose and say that 1 hhave:all the necessary quatifications and none, of the legal disqualifications 10 contract-the said marriage, ind that the following data are true and correct 10 the est of my Knowledge ind information: isi) STR Ate ca eam L ‘Name of CE Applicant ' EQN = THE Moa Date of BirIVAGe Sr aH Teeeihy = ea ‘Ae OFFICE eiynanlopanyT Place of Binh Cra Proms) ‘Se Maa or Fare) Ghaaenip =F TReigian ig Stas © (pr wrerewiousty 7 MARRIED: de ae Place where dasoived| Bina) (Provinsy Date when aiseotved Degrea of Remon ct sarcng peri Wine 6 Father ‘Woriny aah isa) Te etizsnsnip Pe i feciaeies (EF ‘wieaey Ga OF THE CIVIL Ri AR OF [CSUBSCRIBED. AND “SWORN, 1¢ before jme- this ay eo 3 SE of REGIS ‘Gipratre over primed same clea FDISVAEL | : > Philippines: Snalore_over tod name fhe Gl Registra) SUBSCRIBED, AND, SWORN. to) Before. me. thts oe i nat