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CEHNF]CATE OF L]VE BIETH
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01 1 44-EG-004FHA-004 1 0B1001
BEST POSSIBLE IMAGE

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T 00401 1 440040041 002
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8200300
I ll Administralor and Civil Registmr Genenal
1 1
National Statistics Olfice

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For blrtht bolo.. 3'August 19E8/on or tner 3 Augud 19SE

A}FIDAVTT OF ACKNOI,I'LEDGMENT/ADMISSION OF PATERMTY

Wefr, - anil
*e ct;U ieitiotned
oa?entsy',erefit of in this Cntificate of Liac Birlh, ilo hereby solemnly swear that the
iit *tiit^ hmin arc ttye anil correct to the best ol our/ny knowledge and belief.
coflt;ined

.- (SigMlqr' of [tiolhtr)

Comrunity Tax l{o.- Corrimunity Tax No'


----i+
p6E Issued - , - Date lssued -
Place Issued Ptace Issued - '

SIJBSCRIBED AND SWORN to befoilne this of

ot - - -- 'PhiliPPines'

-dry
Firl'loe3i0o'don)

la Prrnt) {Mdra.3}

Not .ppllclbls tor bir$lr bg,Io,z Xl February ,93i

AFFIDAITT FOR DELAYED REGISTRATTON - OF BIRTII


{Eiths the pffi hiuslf if lE ym old. a ec, c hdrr/urothrlguardian m, acmplish lhis rf6dlviL)

r, ' of legal age' single/rnarried


and wirh residence and postal address at
after having been duly sworn to in accordancd with law, do-hereby ddp-ose and say:

L That I am the applicant for the delayed registralion ol my birth,/of the birth of

: .: . rErrlal:t. Slrlrt- - -
Z That l/he/s'EEh-s-b-cnn on--_fOfBga-a1 fiffi at -ftrl
-
e That l/he/she was attendd at birth by - frco*ri-6
L *et Lt'rclslle is a citizen d trc iltrlr-'-- --'
I That mylhis/her parents were
n married * atrffi7;197rr,-m-
n
t-l
rimir wtroce
name is
6 That the reason for the delay in registering *y
7. rhat ;l:**-
&D I th -{fg}-.- of the said person.
.

E t o. the fither/mother/guardian) That am

6**eae.&S--
ol
-
(fiignrtuc Atli.ill -
Csnmuniw Tax )Jo' ---O!61p---
Llate Issued
-&t *-rr5ef--
Eirftarll llrh
I:-+ l:--+-: Irrg:ry-

SUBSCRIBED AND SWORN to beforc ile this a'lt&, doy of l+tOl- , nol -
, Philippines.

(Signatur. o, A.trnlnlslrring o'ti6.0

0\hrD. io Pth)

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01144-EG-004FHA-0041081001

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u/r:
CARMELITA N. ERICTA
Administrator and Civil Registnar General
r 00401 1 440040041 0021 8200300 1
National Statistics Office
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