Municipal Form No. 97 (Form No.

13)
(Revised January 1993)

(To be accomplished in quadruplicate)

REMARKS/ANNOTATION

Republic of the Philippines

OFFICE OF THE CIVIL REGISTRAR GENERAL

CERTIFICATE OF MARRIAGE
Metro Manila
Province _________________________________________
City/Municipality ___________________________________
Manila City

Registry No.
01827374

(HUSBAND)
(first)

Name of Contracting
Parties

(middle initial)

Joaquin Lapid

(WIFE)
(last)

(first)

Manansala

(day)

(month)

(year)

Date of Birth/Age

20

June

1980

Place of Birth

Malate, Manila City

24

24

August

Name of Father

Mateo

(middle Initial)

C.

(last)

(first)

Q.

(last)

(first)

Manansala

C.

(last)

(first)

Manansala

Relationship

Father

Residence

Taft Avenue, Malate, Metro

Manila

Place of Marriage

92

93

Tampipi

(last)

P.

Tampipi

(middle Initial)

Rodolfo

A.

(last)

94

Father

104

105

106

107

Salazar St., Candelaria,

Quezon Province

Minor Basilica of the Black Nazarene (Quiapo Church)

(Office of the/House of/Barangay of/Church of/Mosque of)

1 December 2004
..

99

Tampipi

Quiapo, Manila City, Metro Manila

.
Date:

90

(last)

A.

(middle Initial)

Norma

88

Filipino

(middle Initial)

Mateo

(middle Initial)

87

Filipino

(middle Initial)

Gilda

80

Rodolfo

Filipino

Persons who gave

consent or advice

(Wife)
64324

21

TO BE FILLED UP AT THE
OFFICE OF THE CIVIL
REGISTRAR

(first)

Manansala

Filipino

Citizenship

1983

Salazar St., Candelaria,

Quezon Province

Single

(first)

45782

(age)

Filipino

Single

Name of Mother

(Husband)

Female

Civil Status

Citizenship

(year)

Population reference No.

Candelaria, Quezon Province

Christian

(first)

Tampipi

(month)

Christian

Religion

Santos

(day)

Taft Avenue, Malate,

Manila City

Residence

(last)

(age)

Filipino

Citizenship

(middle initial)

Cristina

Male

Sex (Male or
Female

FOR OCRG USE ONLY:

Address

108

1:00pm
Time:..

(day) (month) (year)

Joaquin L. Manansala
THIS IS TO CERTIFY: That I ..
Cristina S. Tampipi
and I, ....,
both of legal age, of our own free will
and accord, and in the presence of the person solemnizing this marriage and of the witnesses named below, take each other as
husband and wife and certifying further that we:
X

113

have not entered into marriage settlement.

have entered into a marriage settlement, a copy of which is hereto attached.

119

1st

IN WITNESS WHREOF, we signed/marked with our finger print, this certificate in quadruplicate this. day
December
2004
of ..
,
.
(Signature of Husband)

(Signature of Wife)

THIS IS TO CERTIFY: THAT BEFORE ME, on the date and place above-written, personally appeared the aboveMentioned parties, with their mutual consent, lawfully joined together in marriage which was solemnized by me in the presence
of the witnesses named below, all of legal age.

239847

December 1, 2004
Marriage License No. . Issued on ...,
at
Manila City, Metro Manila
.in
favor of said parties, was exhibited to me.
No marriage license was necessary, the marriage being solemnized under Art of Executive
Order No. 209.
The marriage was solemnized in accordance with the provisions of Presidential Decree No. 1083
.
(Signature of Solemnizing Officer)

Parish Priest

..
(Position/Designation)
N/A
...
(Religious Affiliation, Registry No. and Expiration Date, if applicable)
WITNESSES
(Print
Name and Sign)
Crisostomo C. Aquino
Santino Geronimo

Girly O. Abunda

Signature

Katherine N. Padilla
Name in Print

Receiving Clerk
Title or Position

I CERTIFY FURTHER THAT:

RECEIVED AT THE OFFICE OF

THE CIVIL REGISTRAR

Kent Chui

December 2, 2004
Date Received

OATH OF SOLEMNIZING OFFICER

Fr. Ricky M. Gil
I, _______________________________________,
solemnizing officer, do solemnly swear:

That I have ascertained the qualifications of the contracting parties and have found nolegal
impediment for them to marry as required by Art. 34 of the Family Code;
That this marriage was performed in articulo mortis;
That the residence of one or both of the contracting parties: barangay/barrio/sitio
____________________________(and) __________________________ is
so located that there is no means of transportation to enable the concerned party/parties
to appear personally before the civil registrar;
That the marriage was among Muslims or among members of the ethnic cultural communities,
provided the marriage was solemnized in accordance with their customs or practices;
And that I took the necessary steps to ascertain the ages and relationships of the contracting
Parties and that neither of them are under any legal impediment to marry each other.

Signature of Solemnizing Officer

December
2004
1st
SUBSCRIBED AND SWORN to before me this ________
day of _______________,
___________,

November 30, 2004

3528927
who exhibited to me his Community Tax No. _____________________________
issued on ___________________
Manila City, Metro Manila
at _________________________________________.

_____________________________________________________________

Signature over Printed Name of Administering Officer whose

N/A
Commission Expires on _____________________________

375733
Doc. No. _____________________
234
Page No. _____________________
4657
Book No. _____________________
2004
Series of _____________________

NOTE In case of a marriage on the point of death, when the dying party, being physically unable, cannot sign
the Instrument by signature or mark, it shall be sufficient for one of the witnesses to the marriage to sign in his name,
which in fact shall be attested by the person solemnizing the marriage as follows:
I HEREBY CERTIFY that the contracting party ..
being on the point of death and physically unable to sign the foregoing marriage contract by signature or mark,
one of the witnesses to the marriage signed fro him or her by writing the dying partys name and beneath it, the
witness own signature preceded by the preposition By.

...
Signature and Printed Named of Solemnizing Officer