Page 1 of 2, 1 Copy

p..11ST/
1 nwimpllnhnd in auodruplicolo using Dlack ink)

.... . OFFICE
Ropubll c of lho Pl11llppln,~s
or TH( CIVIL REUISTRAR GENERAL
0. -
CERTIF ICATE OF LIVE BIRTH
I I , ,, CEl3lL _ Registry No.

CJ::1:i.U.__1.;..\ll' .__
i.!015 27357
1 Ni'IME (rlml) (~lidd lc ) (Lesl)
RHEIGN MATTHEW SOLEDAD JACINTO
2 SEX(Mnle / Female) 13 DATE OF (Dayi (Monlt>) (VAar)
C _ _MALE... .. BIRTH
H 4 PLACE CF (N1me of Ho$pll11/Cllnlc/ln9tllubonl
I BIRTH House No .. St. llarangay) ·
(6~y/Munlclpallly)

L 1 - - - - -- - -- C.l:B e.uEILCEME R.&...MAIER NIIY HOUSE;,~ CEBU CITY. CEBU

D Sa. TYPE OF BIRTH Sb. If MULTIPLE BIRTH, CHILD WAS Sc. BIRTM ORDER10,d•"'""'~'"' '° r-6:=-.w=E,:-::GHTc=A-:-::T:-::Bc:IRT=-:cH--i
(SIO!Jlo .Twin,Tnplu1 , elo \ (Fl18I, Socond, lhlrtl. 010) (~l,"s:;;'o~;:•ri; :;t:l~.) -hl

SINGl E _NOJ--4P.P..U.C'.ABLE - --F-IRST ___z;JMJ_ grams

7 MAIDEN (Flrsl) , (Middle) (L9!ll __ _
NAME
M~ - - - -- ---1:,R I.JNO,,..ll :-------_..,• ,.,,1i06 Mr,-- - - - - - - - ~~ O=L=E=D~A=0~~:---
08.CITIZE~HIP - --1
11. RELIGION/RELIGIOUSSECT , . ' '•'
\;f
i....a • ,- •.
r ~ - - - - ~ - -.=LJ..ell',I..U... .~ -- -- - -.l,.---[ll.j:J
H 10a. Tolalnumt>ero! 100. No. otchildrcn•trn
.IU:li:L'-<0-LI.JCs,.\,,Ji.k.-_ _ ~_ _' - - - - - t
10c.No. olchlk!ren Dom 11 .0CCUPATION
E CIIJ,.,,.,, bom alive loving incuding this blr111 alive but.., now doad
12. 1\GEattlelmeoll! lis
t.e,(~led yo,n)
R . _L . -1'--c_ __._ _ _O
=---_ _ ___.._ ___ !'JONE - - - - - - '' - - ---'-2_5_ _- i
13. RESIDENCE (HouseNo .. SI., Barangay) (City/Municipalily) (Province) (Counlry)
SABANG, OANAOCllY , CEBU, PHILIPPINES
14. NAME (Flrot) (Middle) (Last)
F
RUEL PABLO JACINTO
~ 15. CITIZENSHIP 16. RELIGION/RELIGIOUS SECT 17. OCCUPATION : 18. AGE al 115 tine of ths
' bWl(C0ff1lleted years)
H FILIPINO ROMAN CATHOLIC ENGINEER
E >--19___R_E_S_ID_EN_C_E- -
(H_ou
_se_N_o.-. Sl...L...,B_a_ra_nga_y_)-----(C_ity_/M_ u_n_lc,pa-
. _li..1.ly-)----(-Pro-v ,-·n_ce_)_ _ __(LCoo_n_try_)_-=.:._ _-t
27

R SABANG OANAO CjlY CEBU PHILS.

MARRIAGE OF PARENTS (II not memed, accomplsh Afflda\/l of Acknowledgement/Admission of Palemily at the Dack.)

20a. DATE (Month) (Day) (Year) T20b. P

...LACNE"T : : ~./ Munlcipality) (Province)
MARRIED _ 0
U-L.DU'!\ll11
21aATTENDANT

__ 1 ysician _ _ 2 Nurse - ~3 Midwife _ _ 4 Hoot (Traditional Birth Attendant) _ _ 5 Others

21b. CERTIFICATION OF ATTENDANT AT BIRTH(,~cian, Nu13e, Midw;Je, Tradmonol 6irth•ttondanl/Hllot, otc.)
(Specify) __ -:-:==~
I hereby certify that I attended the bl h of the child who was bom alive at 5· 47 PM am/pm on Iha dale of birth specilled above.

Address ---,.c...,e=aOt-'UEA. Clfl'R & Ml'i'f'ERN ffV--

Name ,n PrinL _ ___:fili~iHEUL IU.:..JJl:-ITlf il:i,Jl'!.J.L_
-----1'tOt:JS E;1N~E.tBH ll-fC"tffT' . 'I-{-----
Tille o, Posrtt0n Date
22. CERTIFICATION OF INFORMANT 23. PREPARED BY
I he<eby certify that all information supplied are lrue and
correct IO my own knowledge and belief.

Signature / ~ Signature _ __ _ _ __ _,__,.._ _ _ _ __ _

Name in Print ~~I~~ I- SOI FOAO - Name in Print _ __ ...._ilL'-"".><qfJ ->"'--'""""-'-""-'- '-'-'-- -
Relallonsh"klthe Chlld.___ _ _M_O_TH_E_R_ _ _ _ __

Address _ _...:SA:ia.1B~AaiN111Gu,..1JD1B4..iiNu;4u.0.LI.O.i,zvu..,...1C...1E;;,R'"'\.,_I_ __
Dal& _ _ _
Date
24. RECEIVED BY 25. REGISTERED BY
Signature ~ Signature ~
Name In Print - -- ---ill1~~~Hljl:-.
a:tUOA¥- - - - Name ,n Print ATIYA BATAY O
Tltle or PoslUon _ _ _ ___.A&iDN.-.u!Nmf..aSTRAJJYF AIDE Ill TIiie or Position CE GISTRAR
Date Dale
REIIARKSIANNOTATIONS (F e Only)

TO BE FILLED-UP AT THE OFFICE OF THE CIVI. REGISTRAR

8 9 11 13
:· :; _:~
: .:LJ. . . ~ [:.::L~i. _[l. J .L ~ ·. . ·:--· 1i ··- .. . .. 15 16 17
l 1- .. I ' - )9 ,... ·1
, --' ~ - I ..[_l'_J - ·'T°·-- I

07122-7 4-4001LO-01779-BI007
BEST POSSIBLE IMAGE BReN
02217-815SK0C-6
~
CLAIRE DENNIS S. MAPA. Ph. 0.
Ill II II IIIIIII Ill III Ill Ill llll llllllll IIll Ill llll IIIll IIll
T400071224000177907022019007
Document ary
National Statistician and CivU Registrar Gener,
~llpplne StaUstics AuthOrity
FN200813680 Stamp Tax Paid
1■111:t lllff 'ffl~mtlftff
 r'age 2 of 2, 1 Copy
~"\P.~~spc-~ :-- --- ---- - N c..,. PATER NITY
AFFIDAVIT OF ,-..,,<N OWLE DGME NT/AOtrMISSIO
t ·.' .-•:•'
<v .,:. 1 , , •
.~ "
"'i7,.. o, bl, 1J1• on ur otto, J l\vgu; l 1Q80)
(Fe• lllrlh " l>olo"' 3 A.l,q u11 11,lotl)
- RU E!.-AAlil b-9-.J.A.; lt.JTO
Cl ; .· ~ WVe . ~R L!N l)A U;; Dl; ::ilv1A SULl: l l/ll l _ . and

~~ EW SOLED" '.D_JACJJ:JTQ , who was

-,~ on-,__ ---Rl: !ELGhUv l.AITl::i

~ . : _, •• Al ege em/ere tl10 natural rnotner And /or fo th'lr of
PUER....CENl:ER ..8...MA IEmtJ.rt .J,!OUS E, INC.. CEBU err(, EBU
.'o,- ,1,,_,\:;~' t Q.SE~.EMBE£'w?015_ at - - CEBU
I" · ?' ":! ... C' :,, 1r n~ · of
•I ,ifl~ I W s>ore fe wlicWI~ Ihm affidavit lo attes l to
the truthlulness of lhe fore going statements and for purpose-,

l j•lld
ng niy/ou-
nc'<.nowt} g~
I /1 .(i.::A,,,,1
~ ;1:!L!;!E~D
~ ~M~A,...s~o ~==-- - -
~AD
_ _ _R\( LO .JA.CItedNTO
ffii n1e or Fathor) (Slgnorurc bver Printed Nam~ of Mcither)
var Prin

SUBSCR IBED AND SWORN to before me th is

_ day off.P I 8 ZO\w CE~ U CI T\y
ERU NC,,11. LEDESMA SOLEDAQnd _ _R_U_EL_ _ L_O
_ AB
-_ P _C-_I
_ JA. ::r:o::::::: -.
N -w-h o- e-xh-ib-il-ed to me (his/her)
_7_F_E
Issued on _ _ 1 UARY 2015 at
_g_2._3_7_64_8 _ _ _ _ _ _
Commu n i ty Tax Cert. No. __2
CO L_
LA, CEBU , PHI_ S._ _ _
ATTY. f.UZMIN 8 . 8E~/.\ff l(J
Hota,-, Publtc For Cltits .tnd Pr-,11lnce- of C.-t..
IO O. JAl<OSA l(M ST., CEBU CITY
11101. Comm. No l13 11 IJ t·, 1 0 ecc·nibcr 31 11,1.t.._
, , • • • "

" - - o"'°";e Admin,s~ ring Officer •~S7J36 -1.r5, l11i!B~61160Jftjlgeifflm •. ,. Cf RIJ CJT\
RCll NO. 37450, MAY 1991
Name ,nPrrnl -cu-1111 0-111-00 01;,g J/,fil1ts, 12. ~..!;Ir, r,..,
ED REGISTRATION OF BIRTH
AFFIDAVIT FOR DELAY mother. or guardian or the person himsett If 18 years old or ovel'.)
(To be accomplished by the hospltallc llnic administrator, father.
with
I_ _ _ _ _ _ _ _ _ _
_ _ __ , of legal age, single/m arried/div orced/wi dow/wido wer,
_ _ _ __
_________________
resi dence and postal address all_ _ _ _ _ _ _
do hereby depose and say:
after having been duly sworn in accordan ce with law,
--- --- ~ --- --- -
That I am the applicant for the delayed regi stration of:
1.
_ _ _ _ _ on
□ my birth in _ _ _ _ _ _ _ __

C the birth of _ _ _ _ _ _ _ _ _ _ _ _ _
who was born in _ _ _ _ _ _ _ _ __
on

___________ _ who resides al

2. That 1/he/ehe was attended at birth by _ _ _ _ _ _

_ _ _ __ _ _ __
3. Thal I am/he/sh e is a citizen of _ _ _ _ _ _ _

4. Thal my/his/he r parents were O married on

_ _ _ _ _ at _ _ _ _ _ _ __

□
trf my/his/her
not mal7i8d bUt llll&'sl1e was acknowledged/not acknowtedged
_ _ _ __
father whose name is _ _ _ _ _ _ __ _

__
er birth was _ _ _ _ _ _ _ _ _ _ _ _ _
5 That the reason fer the delay In registering my/his/h

(For the applicant only) Thal I am married to - -----------=----

6.
That I am the _ _ _ _ _ _ _ _ of the sald person.
(If the applicant Is other than the documen t owner)

of the foregoing stafements for all legal Intents artd t:lUIPOS8S

.
7 . That I am executing this affidavit to attest to the truthfulness

_
_ _ _ day of _ _ _ _ _ _ _ _ _ _ _ _
tn trU1h whereof, I have affixed my signature below this
_ _ _ _ _ _ _ _ _ _ _ , Philippin es .
..,.,. · · •• at

($ignaJu ~ Over Printed Name of Afflant)

_ _ at
_ _ day of _ _ _ _ __ __ _ _ _ _
SUBSCR IBED AND SWORN to before me this _
s, affianl who exhibited to me his Commun ity Tax Cert.
_ _ __ __ _ _ _ __ _ __ __ _ _ • Philippine
issued on _ _ _ __ _ __ _ _ _ al _ _ _ _ _ __ _ __ _ _ _ _ __

Signature of the Administering Officer Posltlon I TIUe I Oeslgnatioo

Name In Print Address

07122-74-400ILO-01779-BI007 BReN
BEST POSSIBLE IMAGE 02217-B15SK0C~ CLAIRE DENNIS S. MAPA Ph. D.
National Statistician and Civil Registrar General
1111111111111111111111111111111111111111111111111111111111 Docum entary Philippine Statistics Authority
T4000712240001n907022019007
813681
Stamp Tax Paid
.IHH II
:,11111ll·U nrHrn rn