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Oo bq ircomPlfshed in qsadruplicste) FEMARKS/ANNOTAION

Municipal Form No. 102
(R6vis.d Januery t993)
Fepubllc of the PhlliPPnes
OFFICE OF THE CIVIL REGISTRAB GENEfiAL
CERTIFICATE OF LIVE BIRTH
eurd6ly of lypffirir,
5b rnd

Province
- )[t:J
FoI OCNG USE ONLY:
1. NAME (Frs0 . (Middls) ttasq
Populstlon Belerenco Ho.
dohn CarLo 0raot1la Eio
2. sEx 3. DATE OF BIRTH (day) (month) &!ri
lMde-2Fsntd€ I8 i{e 2004 TO 8E FILLED UP AT THE
OFFICE OF THE CIVIL
c 4. PLACE OF (Narnaof Hospird/Olnic/hr,tittrioB/ tcity/Municipslity) (Province) BEGISTRAR
H BIRTH Houss No.. Stre* Eardrgay)
4t
I

L b. IF MULTIPTE BIRTH, ue
5a. TYPE OF BIBTH
D
*- r gnsla 2tm *1Frg
3 eic. $
c BIRTH ORDER (liw births andlgtsl doeths d. [Link] AT BIFTH
lncludiGg lhhdeliv8ry)
Sac (lket, seond. thkd,otc) grBnt8
49 50
6. MAIDEN {Firit) Mddls) ;' {ras0
NAME
lrlabelle R.d.P.o Oraollla
7. CITIZENSHIP 8.
M irili ino 55
o !)il. Totalnumberof b [Link] c [Link].n
T childrBn bgrn Hvingindudhg boin qliva but
tfilB Stlh: ge no* dead:
H ailvoi -----2*-
6r
E 10, OCCUPATION 11 A96 at the tlme
F ilouseYif e otthlsblrth: 2L

12. RESIDENCE (Hous6No., Stroet, Barang&y) $)tyliluniciptfiry) (Prorince)

6{
!" s )
13. NAME (FirEq tMrddb) {ttrr)
F
58 69
A
T 14. ctTrzENsHlP BEUGION { I
H
E 16. 9rcUPATION
4oae t0 T2 t4
R ---?4-Yarts
$. oeTE AI'ID PLACE OF MAFfiI,AGE oF PABENTS (l nor mardrd, accompltsh Attlda,'il or
AcknowledgmenvAdmi $sloeol P€lstnily allho back')

Se .24 2002 ue ol 76 79

1ga ATTENDANT 't

*1 Phyol'1ao *i- 3 Midwffe
Hilal (freditionglMdwilsl
----4
81
ISb. CEFMFrcATION OF BIRTH

rmlpm on
thsGiry ceAily lhal I alondod
0rs dab
stuo ataff i . 2a o'dock
lV" r
signatur6
86 87
Nemg

20.
h
NM
88 91
Aard{€sr@
Slgnahre
Nmekr w-flIa
flelstionshlptolh€.r$u da t be f DAiB
93
2J. PHEPARED ST 22. RECEI\ED OF I
THE E ,-. I

SignahtrE $ignature
94
Nffiain Namo in
Ti&otPo6r'rbn Trtl6 [Link]
oats 0ata

0453 1 -8H-999APR-02037-B 001

BEST POSSIBLE IMAGE
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BReN
07604-804JJ09-9 CARMELITA N.
a-
Administrator and Civil Registrar General
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Stamp Tax Paid National : li: I l,
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