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(a)
(b)
Punzalan
Romanov
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__B
Rosen
Norse
_x_AB
_x_O
___ Schwazenegger
Nebuchadnezzar
Does your rituals involve the use of rice? _y x n Are you a member of LifeSkills? _x y _n
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Child Information
Father Information
Place of Birth:
Panhulan, Batangas Philippines
Date of Birth:
February 25th, 1950
Nationality: Filipino
Religion: Catholic
Home Address:
104-3905 Albert Street,
Burnaby, British Columbia V5C
2E2 Canada
Work Information:
Ship Chandler, Punzalan
Enterprise, Ltd.
Place of Birth:
Zamboanga City
Date of Birth:
April 12th, 1949
Nationality: Filipino
Home Address:
106-3905 Albert Street
Work Information:
Home Maker
Mother Information
3051
MICHAEL PANGAN 604-7730274
Prepared by:
Full Name:
BC Assessment Officer , Eliza:
402-111 Princess Avenue
Vancouver British Columbia V6A
0C9 Canada , 778-945-2989
Ext 1402
Telephone number:
604-678-8278