Tricia Form No, 87 (vised Jentary 2007) Province Republic of the Philippines OFFICE OF THE CIVIL REGISTRAR GENERAL CERTIFICATE OF MARRIAGE To bo accomplched in quadruplicate using biaek mi) Registry No. CityiMunicipality = HUSBAND 1. Name of eee Wire co (ie) (vas) Contracting Paros 2a. Date of ith 2b.Age on Wont) (reap wee) ean me) ~(Chyinturicipattyy {Province} 23. Place of Binh aa Sex (cient 4 Citzenshio ‘Hossa Wo 7. Cui Status ‘Sk, Barangay. ivnunalaly: Provres, Came] (ctynaricpaiy) (Proves) (Coun een | Woase Ne. 8 Barangay, CAAT, Prove, Counivy 8. Name of ‘Fay Father ‘i ta om ‘sy ty 9. Ciizenshp 10: Maiden Name eis ‘@n09) (Goa) ‘of tiotner | citzenatip 7 Carrer 13, Retatonship Fs) ‘ay sre | ‘Wass No. S, Barangoy CyMripaliy,Provins, County) (Ft) ee ‘Pease No, St, Barangay, Ciiunicaly, Promes, Coonyy 15, Place of Marsage: ‘eajnaiaiyy (Gitics ef neniouse siriaragay atic thio 6th 16, Date of Marriage: ay 17. Time of Mariage: (eres) apm ‘ios iia /18. CERTIFICATION OF THE CONTRACTING PARTIES: THIS 1S TO CERTIFY: That | ‘2 husband and wif and coving Tutor ha wo: (Sits or Husbnay ond avo entered. a copy of whicn is hereto attaches / | WITNESS WHEREOF, we have signed imarkod wth ow finger tis carate in quadrupicat tis «both of eget age, of our cnn free wil and accord, and in the presence ofthe prson sclmnizing this mariage and ofthe witnossee named bolo! take each thor have nat entered into @ maiogesetement ay of {Sianuio"or Wty 18, CERTIFICATION OF THE SOLENNIZING OFFICER: THIS IS TO CERTIFY. THAT BEFORE ME, on to date and poe above-wrten, personaly appeared the above-mentioned pers, wth ‘hole mut consent, lly pines together in marrage wich was eolamnzed by me inthe presence ofthe wilesses named below. a of legal age | CERTIFY FURTHER THAT 2. Mariage Lions No, ih favor of aid porter ab Geib i. no marrage license was necessary. the mariage being solemnized under At Iesuod on a of Executive Order No, 208, the mariage was solomrizod in accordance with te provision of Present Decroo No. 1083. (Sonaure Over Pinte Name of Solemrizing Oca) ‘Posiionidesignation) ig Soe ey 20a, WITNESSES (Print Name and Sian) ‘Addins at ths Sane |r RECEIVED BY (RalorRalig Sie, Rea Noa i Signature Name in Print = Tito oF Peston Date Date _ |" REMARKS/ANNOTATIONS (For LCROIOGRG/Shar'a Circuit Registrar Use Oniyy ‘TOBE FILLED-UPAT THE OFFICE OF THE CIViL REGISTRAR 4H 4B SH sw on ow ~w20b, WITNESSES (Print Nome and Sign AFFIDAVIT OF SOLEMNIZING OFFICER h of legal age, Solemnizing Officer of _ with address at —_ . fer having sworn to in accordance with law, do hereby depose and say 4. That Ihave solomnized the mariage between ana . : 2 [| ® That 1 have ascertained the quakficatons of the contig partes and have found no legal impediment for thom to many as required by ice 34 ofthe Family Cove That this mariage was performed in arcewo mors or a he pent of death That the contracting ana boing at the pont of th and pnysieay unabie to sign the foregoing crise of manage by Sghaive oF mark. ane f the wiesses tothe mariage sgn {for him or ner by wring the dying pat’s name end beneath ithe winess’ oun signature procaded by the prepeaton "By 4. Tat the residence of ether party isso located tht there I no means of transpetaion to enable concemed partybarties to appeae personaly before the cu rata, pe ae ©. That the mariage was arnong Muslims or among members ofthe Ethnic Cultural Communities and that the maniage wes solemnlzod in accordance wth their customs and prectices 3. That | 00K the necessary steps to ascertain the ages and elaonship of the contacting pares and that nether of them are under any legal impediment to many each other 4. Tot | om exeoutng nis afidevt to atest othe tutfuness ofthe foregoing statements fora og intents and purposes In trath wheroof, | have attixed my signature below this ___ day of Philippines, ‘Signature Gver Printed Name ofthe Solemnizing Officer SUBSCRIBED AND SWORN to before me thie ___ aay of, ____, Phippines,afiant who exhtited to me his Community Tax Cert a Signature ofthe Adminstring Officer Postion/TitelDesigaation Name in Pt Addeoss AFFIDAVIT FOR DELAYED REGISTRATION OF MARRIAGE p a of logal age, single/marieaisvorcedtaidowlwidower, with residence and postal address —=— ——— — ‘ater having duly swom in accordance with lw do hereby depose and say: 1. That | am the applicant for te delayed registration of ‘ny marriage with tho mariage between Z and in 2. That said mattiage was solemnized by = (Solemnizing Omieor's name) under 2. [[ ]reteious coromony &. [—] ei ceremony ¢[—] Must tes 4, [—] tal tas 9, That he mariage was solemnized: ja with mariage Roenee no. Issued on a = [> water Arce (rrariages of exceptions character 4.016 apptcant e elmer No wile or husband) That Iam a ctizen of and my spouse isa etizan of [ithe sppicant is other than the wife or husband) That me wie Is @etzen of land. the husband sactzen of = 5, Thal the reason for the dela in registering ourtnele manage is _ 6, That | am exeowting hs affidavt o att tothe tutfunaes ofthe foregoing statements for a opal intents ane purposes, In truth whereof, I have affived my signature below this ay of = - ot Philippines. Slonatue Over Printed Namo of fant SUBSCRIBED AND SWORN 10 before me this day of eee _ | Philippines, affiant who exhibited to me his Community Tax Cort. issued on at = Signature ofthe Administring OFFoar Name in Pint Aa