Page 1 of 1, 1 Copy
LIPPINE STATISfIC OHL
(Copy for OCAG)
(To be accomplshedIn qusdruplleate) AEMARKS/ANNOTATION
Mib Form No. 102
Ra January 1993)
Republle f the Phlpplnes
OFFICE OF THE CIVIL REGISTRAR GENERAL
CERTIFICATE OF LIVE BIRTH
or typawriter,
(F ou completely, acourately and lagibly. Use ink 6b and 19a.)
Place X before the appropriate answer in tems 2, 5a,
Province METRO HANILA Reglstry No.
Cly/Munlcipallty PASAY OITY i9_7078 For 0CRG USE ONLY:
(Middle) (Last) Populatlon Referenoe No.
1, NAME (First)
FAITH MARIE ESTALLO TORRES
3. DATE OF BIRTH (day) (month) 6yoar)
2. SEX TOBE FILLED UP AT
THE
1 Male 2 Female 18th 00TOBER 1999 OFFICE OF THE CIVIL
(Province) REGISTRAR
4. PLAOCE OF (Name of Hospital/Clinic/lnstitution/ (Ciy/Municlpality)
BIRTH House No., Street, Barangay) 41
PASAY OIIY GENERAL HOSPITAL PASAY CITY MM,
5a. TYPE OF BIRTH b. IF MULTIPLE BIRTH, CHILD WAS
2 Twin 1First 2Second
X1Single .3Others, Specify
3 Triplet, etc.
deaths
d. WEIGHT ÁT BIRTH
c BIRTH ORDER (Rve births and fetal
gthis delivery)
Inc
1st t. third, etc.) 3.200 grams
(first,
(Middle) (Last)
6. MAIDEN (First)
NAME PRISCILA COTRR ISTALLO
7. CITIZENSHIP
8. RELIGION
PIL. ROBAN CATHOLIC
b. No. of children still c. No. of children
9a. Total number of born alive but
children born living inclucing are now dead:
this birth:
alive: 61
11. Age at the time
| 10. OCCUPATION of this birth: 25 years
HOUSEWIFE
(City/Municipality) (Province)
12. RESIDENCE (House No., Street, Barangay)
10 PQUS CITY
#713 SAN GABRIEL [Link] ANTONIO VAILEY iLaet)
13. NAME (First) (Mkis)
JOSE RONNEI naRAS
15. RELIGiON
14. CITIZENSHIP RONAN -AKHOILIG
FIL. AGs ai the time
IH 17
16. OCCUPATION ofthis birth: vears 70 T2 74
BUSINESSMAN
PARENTS (f not marriad, acoomplish Affidavit of
18. DATE AND PLACE OF MARRIAGE OF
Acknowledgment/Admissian of Paternity at the back.)
HALL.
JARUARY 25,1999- PINRTYAN MINICIPAL
19a ATTENDANT 3 Midwifa
2 Nurse
X 1 Physician 5 Others (Specify)
4 Hilot (Traditional Midwife)
196. CERTIFICATON OF BIRTH o'lock
bcm alve at? 37 PM
Ipeieoy certty th¡t atendep the bith of the child who was
am/pm ghn the date sta bove
Addresso PCGHP BuRGGS ST.
Signature
NamePioAA, JORYLIO,MD. PASAY CTTY M.
EDICAL QPPIYSR II Date 0GIOPHR 25,19g9
Tt
Title or Position
TH1 20. INFORMANT B8 91
Address
T Signature PHISCILA ETORRES
Name in Print MOTHER Date 9rOBER 25, 1999
Rielationship to the child
22. RECEVED AT THE OFFICE OF
Tti 21. PREPARED BY
THE CIVIKRERLSTRAR
15555
Signature Signature
Name in Prin SALANDA NAS
Name in Pria eofnAGISCO CLERK m
Ta orPosition o0TO BER 25,1999
Title or Postion
Date 2700T999
(0 2 /555
Date
05960-97-009VLG-01458-BI019 BReN
BEST POSSIBLE IMAGE 07605-A99VJ03- 6 LISA GRACE S. BERSALES, Ph.D.
National Statistician and Civl Registrar General
Documentary Philippine Statistics Authority
TOO9059600090145804262016019 Stamp Tax Paid
IK200220897
