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ReDublic of the PhiliPPines
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Sectlon
Koronadal B€nch-Member Services
Koronadal CltY

Daie ' 02'106'18

FoR: Office of the Civil Registrar

Local CNil Registrar
ISULAN, SULTAN KUDAMT

Thru: SERAFIN G' HINGCO

Branch Head
TACURONG BMNCH

SUBJECT: LAGUNDINO, II,IiOISES S'

sSNUMBER: 09-0846126-2

Sir/Maiiame:
"""'''-*"p]"""" the issuance ol the original copy of documenus
*nfirm
listed below allggedly issued by your ofric€'

BIRTH CERTIFICATE

us with the correct data on your records'

lf incorrbct, please check below and fqrnish

Thank you.
verrrruulB
sUZETTE/H. PUrilFlcAcloN
Br+ch Head'

(Please retum the duly filled'uP reply slip herewith attached)

/connnn"o Not Confirm€d

With amendments of Name and Date of Birth Reqson :

From :

To

w/wthout amendmenus

i9ueal,t Data olRelistalion /4A7 . "1'8. lry'/

LCR of

Date ol Birth u,ltP'e,,- '1:L, t'lttV Registry Numbsr 1t ' 9t' 4

Date oI Ma(iage Book No ' Series of

- -
Signature Over |alo"/o
,\ 4tata! lnlormanuAuthorized Off icer

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Poslion/ lssuing Otfic€