Municipal Form No. 97 (Form No.
13) (To be accomplished in quadruplicate)
(Revised January 1993)
REMARKS/ANNOTATION
Republic of the Philippines
OFFICE OF THE CIVIL REGISTRAR GENERAL
CERTIFICATE OF MARRIAGE
Pampangga
Province _________________________________________ Registry No.
San Fernando
City/Municipality ___________________________________ 78284-54
(HUSBAND) (WIFE)
FOR OCRG USE ONLY:
Population reference No.
(first) (middle initial) (last) (first) (middle initial) (last)
Name of Contracting
Parties Anthony A. Javier Theresa Janice C. Treceda (Husband)
(day) (month) (year) (age) (day) (month) (year) (age)
Date of Birth/Age 12 November 1971 25 24 December 1973 23 (Wife)
Place of Birth Marikina City, Metro Manila Muntinlupa City, Metro Manila
TO BE FILLED UP AT THE
OFFICE OF THE CIVIL
Sex (Male or Male Female REGISTRAR
Female
80
Citizenship Filipino Filipino
324 Zamora St., Marikina 983 Burgos St., Muntinlupa City,
Residence
City, Metro Manila Metro Manila 87
Religion Christian Christian
Civil Status Single Single 88 90
(first) (middle Initial) (last) (first) (middle Initial) (last)
Name of Father Antonio Gonzaga Javier Gregorio Tan Treceda
92 93
Citizenship Filipino Filipino
(first) (middle Initial) (last) (first) (middle Initial) (last)
Name of Mother Ramona V. Arbating Nathalia Q. Cruz
94
Citizenship Filipino Filipino
(first) (middle Initial) (last) (first) (middle Initial) (last) 99
Persons who gave
consent or advice Antonio R. Javier Gregorio T. Treceda
Relationship Father Father 104 105
324 Zamora St., Marikina 983 Burgos St., Muntinlupa City,
Residence
City, Metro Manila Metro Manila
106 107
Place of Marriage San Agustin Parish
……………………………………………………………………………
(Office of the/House of/Barangay of/Church of/Mosque of)
San Fernando, Pampanga 108
……………………………………………………………………………………………….
Address
Date: 30 January 1996
………………………………….. 1:00pm
Time:……………………………..
(day) (month) (year)
Anthony Arbating
THIS IS TO CERTIFY: That I …………………………………………………………………………………………..
Javier 113
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:
have not entered into marriage settlement.
119
have entered into a marriage settlement, a copy of which is hereto attached.
IN WITNESS WHREOF, we signed/marked with our finger print, this certificate in quadruplicate this……………. day
of ………………………………….. , ……………………
RECEIVED AT THE OFFICE OF
THE CIVIL REGISTRAR
………………………………………………………………. ………………………………………………………
(Signature of Husband) (Signature of Wife)
Signature
THIS IS TO CERTIFY: THAT BEFORE ME, on the date and place above-written, personally appeared the above-
Mentioned 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. Name in Print
I CERTIFY FURTHER THAT: Title or Position
Marriage License No. …………………………. Issued on ………………………………………...…, at Date Received
…………………………………………………….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
Joshua Rodriguez (Print Name and Sign) Mark Anthony Dalog
……………………………………………… ……………………………………………………
Melanie Viernes Lilibeth Agustin
……………………………………………… …………………………………………………….
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
SUBSCRIBED AND SWORN to before me this ________ January
30th day of _______________, 1996
___________,
81728172
who exhibited to me his Community Tax No. _____________________________ 5 January 1996
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 party’s name and beneath it, the
witness’ own signature preceded by the preposition ‘By’.
……………………………………………………...
Signature and Printed Named of Solemnizing Officer
