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
Pampangga
Province _________________________________________
City/Municipality ___________________________________
San Fernando

Registry No.
78284-54

(HUSBAND)
(first)

Name of Contracting
Parties

(middle initial)

Anthony
(day)

(last)

A.

(month)

Javier
(year)

12 November 1971

Date of Birth/Age

(WIFE)

(age)

25

Marikina City, Metro Manila

Place of Birth
Sex (Male or
Female
Citizenship

Theresa Janice
(day)

Filipino

Filipino

(first)

(first)

Name of Mother

Ramona

(first)
Persons who gave
consent or advice

(middle Initial)

(last)

(first)

Gregorio

Gonzaga Javier

Place of Marriage

80

(middle Initial)

Tan

87

(middle Initial)

V.

(last)

Arbating

(first)

Nathalia

(middle Initial)

88

90

92

93

(last)

Treceda

(last)

Q.

Cruz

(middle Initial)

(last)

94

Filipino
(middle Initial)

Antonio

R.

(last)

(first)

Javier

Gregorio

T.

Father

104

105

106

107

983 Burgos St., Muntinlupa City,

Metro Manila

San Agustin Parish

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

San Fernando, Pampanga
30 January 1996
..

99

Treceda

Date:

(Wife)

TO BE FILLED UP AT THE
OFFICE OF THE CIVIL
REGISTRAR

Filipino

324 Zamora St., Marikina

City, Metro Manila

Residence

23

Single

Father

Relationship

(age)

Christian

Filipino

Citizenship

(year)

983 Burgos St., Muntinlupa City,

Metro Manila

Filipino

Citizenship

(Husband)

Treceda

December 1973

Female

Antonio

Name of Father

Population reference No.

(last)

Muntinlupa City, Metro Manila

Single

Civil Status

C.

(month)

24

Christian

Religion

(middle initial)

Male

324 Zamora St., Marikina

City, Metro Manila

Residence

(first)

FOR OCRG USE ONLY:

Address

108

1:00pm
Time:..

(day) (month) (year)

Anthony

Arbating

Javier

THIS IS TO CERTIFY: That I ..

Ramona Cruz Treceda
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:

113

have not entered into marriage settlement.

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

119

IN WITNESS WHREOF, we signed/marked with our finger print, this certificate in quadruplicate this. day
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.

Marriage License No. . Issued on ..., at

.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

Rev. Fr. Honesto Ongtioco

.
(Signature of Solemnizing Officer)

Parish Priest

..
(Position/Designation)
...
(Religious Affiliation, Registry No. and Expiration Date, if applicable)
WITNESSES
(Print
Name and Sign)
Joshua Rodriguez
Mark Anthony Dalog

Melanie Viernes

Signature
Name in Print
Title or Position

I CERTIFY FURTHER THAT:

RECEIVED AT THE OFFICE OF

THE CIVIL REGISTRAR

Lilibeth Agustin

Date Received

OATH OF SOLEMNIZING OFFICER

Rev. Fr. Honesto Ongtioco
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

January
1996
30th day of _______________,
SUBSCRIBED AND SWORN to before me this ________
___________,

81728172
5 January 1996
who exhibited to me his Community Tax No. _____________________________
issued on ___________________
San Fernando, Pampangga
at _________________________________________.

Rosanna T. Garcia
_____________________________________________________________
Signature over Printed Name of Administering Officer whose
10 September 1997
Commission Expires on _____________________________
Doc. No. _____________________
Page No. _____________________
Book No. _____________________
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