‘Municipal Form No 102 CT bo ocala aaatpcato wing Blak rH) (Revised August 2016}, Republic of the Philippines OFFICE OF THE CIVIL REGISTRAR GENERAL CERTIFICATE OF LIVE BIRTH pane “02144 98 vince_sorsocon City/Municipality __sorsoconcin - 9 7 NAME Fist Tiisaay Ta RYLEE UyOLA GAMIT C| 2 SEX (isiaFematay 3. DATE OF ‘oan ‘Wenty Wea H MALE ens 2 SEPTEMBER 2021 are of HeapigrGmeTraTaTERT ina (Proving | | BLAGE OF Ete eaten) Conia) Cos) L ‘SMMGHHSC. SORSOGON CITY SORSOGON D_ Sa TYPE OF BIRTH So.IF MULTIPLE BIRTH, CHILD WAS | Se.BIRTH ORDER foam oir orn. |g, WEIGHT AT BIRTH (Single, Twin, Tele, te) (Fist, Secone, Ti, te) ieee Seene eal l INGLE a SECOND. —3,100_ grams] 7 MAIDEN ay ‘Tiaay (aay NAME M REIZL LOZADA UYOLA, | & OTZENSHIP 9. RELIGIONIRELIGIOUS SECT T FILIPINO 2 ROMAN CATHOLIC “Da. Tal murer of | 10D. No.of een sil ¥0S. No of ern bom | Ti. OCCUPATION LUGE ane oe H1 7°" ena cig | oe how | copa ya E 2 2 ° BUSINESSWOMAN 36 R [13 RESIDENCE (House No, St, Barangay) ‘Graton (Province) ‘Cousin |__ #101 ASUNCION ST. BRGY. 2 POBLACION _ STA. MAGDALENA SORSOGON __ PHILIPPINE: F | NAME (Fes) ‘ile) ta A __REMAR GARALDE amir 7 15 CITZENSHIP 76, RELIGIONRELIGIOUS SECT | 17. OCCUPATION | TR. AGE ate ine of is Dinh comptes yeas) H FILIPINO ROMAN CATHOLIC BRGY. TREASURER 37 E/19. RESIDENCE (House No, St, Barangay) (CityiMuricipatty) (Provines) (Country) R| 4101 ASUNCION ST. BRGY.2 POBLACION _STA.MAGDALENA __soRSOGON _pHILIPPINES _| MARRIAGE OF PARENTS (if not maried, acomplch Alfdavi of AcknowladgomentiAdmssion of Pater st the back) oni) (ayy (Weary 208. PLACE (Ciyinaniapaity Province) (Country JANUARY 102019 ROSIN SORSOGON _ PHILIPPINES 2a, ATTENDANT _ S Migwte _4 Hot Tractonal Birth Atendant) __5 Others (Specity) _ 21b. CERTIFICATION IDANT AT BIRTH (Physician, Nuree, Midwife, Tadiional Bith AtlendaniHiot, ic) dog the birth of the chikd who was born alive at 2:28 PM amipm on the date of bith specified above, ‘Signature Address SORSOGON CITY Name in Print ___ ROSA UY DEALCA, MD. RSOGON, ‘Tite or Position _ATTENDING PHYSICIAN Date___ September 22, 202 — 22. CERTIFICATION OF INFORMANT 25, PREPARED BY hereby certly that all information supplied are true and correct to my own knowledge and belie Signature Signature Name in Pi Name in Pint _ REBE: Flotorei tthe Chid_ FATHER Tie or Postion Addro#é01 ASUNCION ST. BRGY.2 POR. STA MAGDALENA SORSOGON Date _ ae September 22,2021, \ Wi REGEWVED BY . 25. REGISTERED AT THE OFFICE OF THE Cg BLGISTRAR Name in Print IMARJORIE P, ENTICO Name in Print SALVACION E. MO} LED f Title or Position. ° Title or Position _ CITY CIVIL REGIS Date OCT 97 202 Date OCT Ob? ut