これはCERTIFICATE OF MARRIAGE（結婚証明書）の原本コピーです。2000/03現在。
| Municipal Form
No.97 (Form No.13) (To be accomplished in
quadruplicate) (Revised January 1993) Republic of Philippines |
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| Province METRO
MANILA City/municipality QUEZON CITY |
Registry No. ****-**** |
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| Name of Contracting Parties |
|
||
| （first）（middle initial）（last） ****** ****** ****** |
（first）（middle initial）（last） ***** ****** *． *********** |
||
| Date
of Birth /Age |
（day） （month） （year）(age) ＊＊ ***. ＊＊＊＊ ＊＊ |
（day） （month） （year） (age) ＊＊ ***. ＊＊＊＊ ＊＊ |
|
| Place of BirthPlace of Birth | ********* ***, GUMMA PREF., JAPAN |
QUEZON CITY M. MLA. | |
| Sex(Male
or Female) |
MALE | FEMALE | |
| Citizenship | JAPANESE | FILIPINO | |
| Residence | *********** ********** ****-KU, SENDAI CITY., JAPAN |
**** ********** ST, ********, Q.C. | |
| Religion | BUDDHISM | CATHOLIC | |
| Civil Status | SINGLE | SINGLE | |
| Name
of Father |
（first）（middle initial）（last） ******** *** TANAKA |
（first）（middle initial）（last） ****** *. *********** |
|
| Citizenship | JAPANESE | FILIPINO | |
| Name
of Mother |
（first）（middle initial）（last） *** **** TANAKA |
（first）（middle initial）（last） ******* *. *********** |
|
| Citizenship | JAPANESE | FILIPINO | |
| Person
who Gave consent Or advice |
（first）（middle initial）（last） NOT APPLICABLE |
（first）（middle initial）（last） NOT APPLICABLE |
|
| Relationship | N/A | N/A | |
| Residence | N/A | N/A | |
Place of Marriage ROOM 18 LEGISLAYIVE WING (Office of the/House of/Barangay of/Church of/Mosque of) SECOND FLOOR, CITY HALL, QUEZON CITY Address Date ** ***. **** Time 10:00 A.M.
| THIS IS TO CERTIFY:THAT I、 ******
****** Tanaka 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 a marriage settlement |
□ |
have entered into a marriage settlement, a copy of which is hereto attached. |
| IN WITNESS WHEREOF, we
signed/marked with our finger print, this certificate in
quadruplicate this 18th day of *******, **** |
|
| ****** ****** Tanaka ***** ****** *. ********** （Signature of Husband） （Signature of Wife） |
|
| 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. | |
| I CERTIFY FURTHER THAT: | |
|
Marriage No. ****** issued on ******* **, **** atIn 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 |
| *******
*. ********* (Signature of solemnizing Officer) |
|
| MINISTER (Position/Designation) |
|
| JACM
**-****-** DECEMBER **, **** (Religious Affiliation, Registry No. and Expiration Date if applicable) |
|
. |
|
WITNESSES |
|