Cagayan

Tuguegarao City

FRANCHESKA LIANA BERMILLO CARANGUIAN

Female 9 June 2016

Cagayan Valley Medical Center, Tuguegarao City, Cagayan

Single First 2892

BABYLYN GARO BERMILLO

Filipino Roman Catholic

1 1 0 None 19

Arcon, Tumauini, Isabela Philippines

SAM BERIÑIO CARANGUIAN

Filipino Roman Catholic Laborer 22

Arcon, Tumauini, Isabela Philippines

February 15, 2016 Tumauini, Isabela Philippines

xx

12:19AM

CVMC, Carig,
MARI-CARR C. IBERA, MD Tuguegarao City, Cagayan
Medical Officer III 8-Sep-19

SAM B. CARANGUIAN VIRGINIA U. TAGUINOD

Father Administrative Officer V
Tumauini, Isabela 08-Sep-19
08-Sep-19

.
 Cagayan
Tuguegarao City

MAKENRICH PASION TOBIAS

Female 12 June 2016

Cagayan Valley Medical Center, Tuguegarao City, Cagayan

Single Second 2495

MACRINA ALARIO PASION

Filipino Roman Catholic

3 3 0 None 28

Sta. Catalina, Quirino, Isabela Philippines

ZALDE ADRIANO TOBIAS

Filipino Roman Catholic Farmer 29

Sta. Catalina, Quirino, Isabela Philippines

June 18, 2011 Quirino, Isabela Philippines

xx

2:16AM

CVMC, Carig,
CORAZON W. ADVIENTO, MD Tuguegarao City, Cagayan
Medical Officer III 8-Sep-19

ZALDE A. TOBIAS VIRGINIA U. TAGUINOD

Father Administrative Officer V
Quirino, Isabela 08-Sep-19
08-Sep-19

.
 Cagayan
Tuguegarao City

PHILIP CALIX ANDAL DANIEL

Male 30 June 2016

Cagayan Valley Medical Center, Tuguegarao City, Cagayan

Twin Second Third 2381

MARILYN CABUNOT ANDAL

Filipino Roman Catholic

4 4 0 None 31

Servando St. Balzain East, Tuguegarao City, Cagayan Philippines

ROBIN CABALZA DANIEL

Filipino Roman Catholic Driver 32

Servando St. Balzain East, Tuguegarao City, Cagayan Philippines

February 12, 2012 Tuguegarao City, Cagayan Philippines

xx

8:51PM

CVMC, Carig,
MARLA A. LLANTO, MD Tuguegarao City, Cagayan
Medical Officer III 8-Sep-19

ROBIN C. DANIEL VIRGINIA U. TAGUINOD

Father Administrative Officer V
Tuguegarao City, Cagayan 08-Sep-19
08-Sep-19

.
 Cagayan
Tuguegarao City

JHUN MARK AGGABAO TULIAO

Female 12 October 2016

Cagayan Valley Medical Center, Tuguegarao City, Cagayan

Single Second 3062

MA. ANGELICA DAYAG AGGABAO

Filipino Roman Catholic

2 2 0 Municipal Employee 28

Centro, Enrile, Cagayan Philippines

JAYSON VENTURA TULIAO

Filipino Roman Catholic Engineer 30

Centro, Enrile, Cagayan Philippines

January 03, 2012 Enrile, Cagayan Philippines

xx

3:47PM

CVMC, Carig,
MARI-CARR C. IBERA, MD Tuguegarao City, Cagayan
Medical Officer III 08-Sep-19

JAYSON V. TULIAO VIRGINIA U. TAGUINOD

Father Administrative Officer V
Enrile, Cagayan 08-Sep-19
08-Sep-19
 Cagayan
Tuguegarao City

KNITZ NATHAN MOLINA ANGEL

Male 24 February 2017

Cagayan Valley Medical Center, Tuguegarao City, Cagayan

Twin Second 3rd 2438

JOYLIN BAUTISTA MOLINA

Filipino Roman Catholic

3 3 0 None 21

Remus, Baggao, Cagayan, Philippines

REYMON VIDAL ANGEL

Filipino Roman Catholic Farmer 25

Remus, Baggao, Cagayan, Philippines

May 15, 2014 Baggao, Cagayan Philippines

xx

8:25PM

CVMC, Carig,
JANET M. CHUA, MD Tuguegarao City, Cagayan
Medical Officer III 08-Sep-19

REYMON V. ANGEL BELEN V. JULARBAL, MPA

Father Administrative Officer III
Baggao, Cagayan 08-Sep-19
08-Sep-19
 Cagayan
Tuguegarao City

MARCELO JR. TAPPA BANONGNA

Male 18 September 2018

Cagayan Valley Medical Center, Tuguegarao City, Cagayan

Single Second 2900

ANABEL GARCIA TAPPA

Filipino Roman Catholic

2 2 0 None 24

San Vicente, San Pablo, Isabela Philippines

MARCELO PANITIO BANONGNA

Filipino Roman Catholic Farmer 27

San Vicente, San Pablo, Isabela Philippines

June 08, 2015 San Pablo, Isabela Philippines

xx

3:05 AM

CVMC, Carig,
JHOANNE EIZLE G. PERALTA-IBAÑEZ, MD Tuguegarao City, Cagayan
Medical Officer III 08-Sep-19

FERNANDO D. PARAGAS
ANABEL G. TAPPA
Mother Administrative Assistant I
San Pablo, Isabela 08-Sep-19
08-Sep-19
 Cagayan
Tuguegarao City

HANNAH MICHAELLA BITALO RAZOTE

Female 24 February 2017

Cagayan Valley Medical Center, Tuguegarao City, Cagayan

Single Second 3231

CRISTINE BAQUIRAN BITALO

Filipino Methodist

2 2 0 Nurse 34

Antonio St. Carig Sur, Tuguegarao City, Cagayan, Philippines

MICHAEL REY LUIS RAZOTE

Filipino Roman Catholic Physician 32

Antonio St. Carig Sur, Tuguegarao City, Cagayan, Philippines

October 31, 2007 Tuguegarao City, Cagayan Philippines

xx

9:19 AM

CVMC, Carig,
CRISELINE D. TOLENTINO,MD Tuguegarao City, Cagayan
Medical Specialist II 08-Sep-19

MICHAEL REY L. RAZOTE BELEN V. JULARBAL, MPA

Father Administrative Officer III
Tuguegarao City, Cagayan 08-Sep-19
08-Sep-19
 Cagayan
Tuguegarao City

DANISH KHAN TAGUNA SERRANO

Male 16 August 2018

Cagayan Valley Medical Center, Tuguegarao City, Cagayan

Single First 2778

JAQUELIN SIMON TAGUNA

Filipino Roman Catholic

1 1 0 None 24

Gumarueng, Piat, Cagayan Philippines

JOEY BATALLONES SERRANO

Filipino Roman Catholic None 22

Gumarueng, Piat, Cagayan Philippines

NOT MARRIED

xx

2:13 AM

CVMC, Carig,
MARIE ELIZABETH P. DELA CRUZ, MD Tuguegarao City, Cagayan
, Medical Officer III 08-Sep-19
D
JAQUELIN S. TAGUNA MYRA P. AGLUBA
Mother Administrative Assistant II
Piat, Cagayan 08-Sep-19
08-Sep-19
JOEY B. SERRANO
DANISH KHAN T. SERRANO
August 16, 2018 Cagayan Valley Medical Center

JOEY B. SERRANO

City Civil Registrar

Tuguegarao City, Cagayan

 Cagayan
Tuguegarao City

TIMOTHY JOHN CACHO

Male 19 May 2017

Cagayan Valley Medical Center, Tuguegarao City, Cagayan

Single First 1927

AILYN JACOBEN CACHO

Filipino Roman Catholic

1 1 0 None 22

Sta. Isabel Sur, Ilagan City, Isabela, Philippines

xx

###

CVMC, Carig,
FLEURJELYN REYNA C. MANANGO, MD Tuguegarao City, Cagayan
Medical Officer III 8-Sep-19

AILYN V. DIAZ ZENAIDA C. GREGORIO

Mother Statistician III
Ilagan City, Isabela 08-Sep-19
08-Sep-19

.
R.A. No. 9255 Form No. 1
(Revised March 2016) Registry Number __________________

)
)SS

AFFIDAVIT TO USE THE SURNAME OF THE FATHER

I, CHARMAGNE ANNE C. CRISOSOTOMO Filipino SINGLE 24 years old, a resident of

Affiant's Name Citizenship Civil Status Age

Centro 03, Tuguegarao City, Cagayan after having been dully sworn to in accordance with law, do hereby declare that
Complete Address

1. I am seeking to use the surname MABUNGA in:

a) my Certificate of Live Birth /Report of Birth, pursuant to R.A. No.: 9255.

b) X the Certificate of Live Birth/ Report of Birth of SOFIA MAE CRISOSTOMO MABUNGA

who is my Daughter pursuant to R. A. 9255.

2. I/He/She was born on July 23, 2016 at Tuguegarao City, Cagayan Philippines
(Municipality) (Province) (Country)

3. My/The birth was recorded under Registry No. on (if applicable).

(Registry Number) (Date of Registration)

4. The Public Document or the Private Handwritten Instrument was recorded under Registry No. on
at the Local Civil Registry Office(LCRO)
(Date of Registration)
Philippine
Foreign Service Post(PFSP) of ,Philippines (if applicable)
(Municipality) (Province) (Country)

5. I am filing this AUSF at the LCRO/PFSP of Tuguegarao City, Cagayan ,Philippines in accordance with
(Municipality) (Province) (Country)

R.A. No. 9255 and its Revised Implementing Rules and Regulations.

6. I hereby certify that the statements made herein are true and correct to the best of my knowledge and belief.

7. In witness hereof, I hereby affix my signature on this day of August 2016 at Tuguegarao City, Cagayan

CHARMAGNE ANNE C. CRISOSOTOMO

. Signature over printed name of Affiant

SUBSCRIBED AND SWORN to before me this day of in the municipality of Tuguegarao City
affiant exhibiting his issued at on
I certify that I personally examined the affiant and the he/she voluntarily executed the foregoing affidavit and
understood the contents thereof.

Administering Officer

Doc. No.
Page No.
Book No.
Series of
AMELITA MAMBA, MD Visiting Consultant

CARLA JANE M. BAGAYAO, MD

CHARISSE ZYLMA T. HURTADO, MD Medical Officer III

CHERYL ERIKA GAMMAD, MD Medical Specialist II

CLAIRE G. GONZALEZ, MD Medical Specialist III

CLEMENCIA D. LASAM, MD Medical Specialist II

CORAZON W. ADVIENTO, MD Medical Officer III

CRISELINE D. TOLENTINO,MD Medical Specialist II

EDUARDO M. BADUA III, MD, FPSP OIC-Medical Center Chief II

ELLEN MAY P. DE GUZMAN, MD Medical Specialist II

FAYE SHAMAINE B. DUMELOD, MD Medical Officer III

FE HERMINIA P. DANAO-MACARUBBO, MD

JACQUELINE B. PUA, MD Medical Specialist II

JANET M. CHUA, MD Medical Officer III

JHOANNE EIZLE G. PERALTA-IBAÑEZ, MD Medical Officer III

JOSE DANTE V. MARCOS,MD Medical Specialist IV

MA. ENRICA M. PATTAGUAN, MD Medical Officer III

MAE M. PANALIGAN, MD Medical Officer III

MARI-CARR C. IBERA, MD Medical Officer III

MARICEL RAMOS PALATTAO,MD

MARLA A. LLANTO, MD Medical Officer III

MARRIANE ROWENA D. BAGGAY, MD

MYERA ANGELICA G. ANCHETA, MD Medical Officer III

NOEL B. ARNEDO, CPA

RODA A. UY, MD Medical Specialist II

SHAHREZA B. NADAL,MD Medical Specialist II