Tricia Form No, a7 (Rovised 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 \S HUSBAND 1. Name of, See Wire cy ae) (vas) Contracting Paros 2a. Date of ith 2b.Age on ony (ery wey an mo) © (Ctyinturicipatty) {Province} 23. Place of Binh 4a Sex (Geena — 4 Citzenshio ‘owsa wo 7. Ci Status ‘Sk, Barangay. Giviunalaly: Provres, Cammy] | (ctynnricpaiy) (Proves) (Comin een | foase No, 8 Barangay, Cian, Prove, Counivy 8. Name of Fay Father ‘i tar wm ‘aay i 5. Ciizenship 10: Maiden Name eis ‘on09) oat) ‘of tiotner | i citzenatip | arsrter 13, Retatonship sy (a) sre | ‘Css No, S, Barangoy CyMrialy,Provins, County) (Ft) eed ‘Pease No, St, Barangay, Ciiunicaly Promes, Coony) 15, Place of Mariage: ‘eajnaiaigy (ities neniouse sitiaraay atic thio 6th 16, Date of Marriage: ay 17. Time of Mariage: (eres) ape ‘ios iia 118. CERTIFICATION OF THE CONTRACTING PARTIES: THIS 1S TO CERTIFY: That | ‘25 husband and wif and coving Tutor ha wo: (Sits or Husnay ond avo entered. a copy of whicn is hereto attaches / | WITNESS WHEREOF, we have slnod imarkad wth ow finger tis carate in quadrupicata tis «both of egal 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 _Sianiio"or Wty 18, CERTIFICATION OF THE SOLEMNIZING OFFICER: THIS IS TO CERTIFY. THAT BEFORE ME, on the date and poe above-wrten, personaly appeared the above-mentioned pers, wh ‘hole mut consent, lly pines together in marrage wich was eolamnzed by me inthe presence ofthe wilesses named below. a of lege age | CERTIFY FURTHER THAT 2. Mariage Liconso No, ih favor of aid porter, ab Sth i. b. no marrage license was necessary. the mariage being solemnized under Art Iesuod on a of Executive Order No, 208, the mariage was solomnizod in accordance with te provision of Present Decroo No. 1083. (Sonaure Over Pinte Name of Solemrizing Oca) ‘Posiionidesignation) ig Seah eg 20a, WITNESSES (Print Name and Sian) ‘Addons at ths Sade | 2r RECEIVEDBY (RalorRalig Sar, Reay Noa Ei Signature Name in Print - to oF Peston Date Date _ |" REMARKS/ANNOTATIONS (For LCROIOGRG/Shara Circuit Registrar Use Only ‘TOBE FILLED-UPAT THE OFFICE OF THE CIViL REGISTRAR 40H 4B SH Bw 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 sy 1. That Ihave solomnized the mariage between ana - : 2 [| ® That 1 have ascertained the quabicatons of the contig partes and have found no tgal impediment for thom to many as required by Ace 34 ofthe Family Cove: That this mariage was performed in arcwo mors of at he pent of death That the contracting ana boing at the pont of and pnysieafy unable to sign the foregoing caricate of manage by Sghaive oF mark. ane of the wiesses tothe mariage sgn {for him or ner by wring the dying party's name end beneath ithe winess’ oun signature procaded by the prepeaton "By 4. Tat the residence of ether party isso local tht there I no means of transpetaion to enable concemed partybarties to appeae personaly before the cu rata, pe a ©. That the mariage was arnong Muslims or among members ofthe Ethnic Cultural Communities and thatthe manage wes solemnlzod in accordance wth their customs and prectices 3. That | 00k the necessary stops to ascertain the ages and elaonship of the contacting pares and that nether of them are under any toga impediment to many each other 4, Tht | om executing nis fidavt to atest o the tutfulness ofthe foregoing statements for al og intents and purposes In trth 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, ____, Phtippines, afiant who exhited to me his Community Tax Cert at Signature ofthe Administring Offeer Poston/TielDesigaation ‘Name in Pent Adios. AFFIDAVIT FOR DELAYED REGISTRATION OF MARRIAGE p a of logal age, single/marieaisvorcedtaidowlwidower, with residence and postal addiess ——— ——— — ‘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 7 and io 2. That said mattiage was solemnized by = (Solemnizing Omieor's name) under 2. [[ ]reteious coromony &. [—] ei ceremony ¢[—] Must tes, [—] tal tas 9, Tat he mariage was solemnized: [ja with mariage Roense no. Issued on a = [p> water Arce (rrariages of exceptions character 4.016 appicant ie elmer No wile or husband) That |am a ctizen of nd my spouse isa etizan of [ithe sppicant is other than the wife or husband) That me wie Is @etizen of land. the husband actzon of = '5, Thal the reason forthe dela in registering ourtnele manage is _ 6, That | am exeowting this affidavt to att to the tutfunoes ofthe foregoing statements for a opal intents ane purposes, In truth whereof, I have affived my signature below this ay of 7 - oy «Philippines. Slonatue Over Printed Namo of fant SUBSCRIBED AND SWORN 10 before me this day of eet _ | Philippines, affiant who exhibited to me his Community Tax Cort. issued on at _ Signature ofthe Administring OFFoar Name in Pint Adi