Municipal Form 102 is a document used to report the financial position of a municipality. The form requires information on the municipality's assets, liabilities, and fund balances. Making sure your municipality is up-to-date on their Municipal Form 102 can be extremely important for both state and federal reporting purposes. This guide will help you understand what information is required on the form, as well as how to complete it correctly. Municipalities must file an annual statement of affairs or financial condition report with their respective Department of Treasury (DOT) in order to comply with Pennsylvania’s Fiscal Code Chapter 494.
Here is the information regarding the file you were looking for to fill out. It can show you the amount of time you will require to complete municipal form 102, what fields you will have to fill in and a few additional specific details.
Question | Answer |
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Form Name | Municipal Form 102 |
Form Length | 2 pages |
Fillable? | No |
Fillable fields | 0 |
Avg. time to fill out | 30 sec |
Other names | live birth form, municipal form no 102, birth certificate form, birth certificate sample |
Municipal Form No. 102 |
(To be accomplished in quadruplicate) |
(Revised January 1993) |
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Republic of the Philippines |
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OFFICE OF THE CIVIL REGISTRAR GENERAL |
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CERTIFICATE OF LIVE BIRTH |
(Fill out completely, accurately and legibly. Use ink or typewriter. Place X before the appropriate ANSWER IN ITEMS 2, 5A, 5B AND 19A.)
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Province _________________________________________ |
Registry No. |
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City/Municipality ___________________________________ |
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REMARKS/ANNOTATION
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1. |
NAME |
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(Middle) |
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(Last) |
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2. |
SEX |
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3. DATE OF BIRTH |
(day) (month) (year) |
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______ 1 Male |
_______ 2 Female |
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4. |
PLACE OF |
(Name of Hospital/Clinic/Institution/ |
(City/Municipality) |
(Province) |
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BIRTH |
House No., Street, Barangay) |
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5a. TYPE OF BIRTH |
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b. IF MULTIPLE BIRTH, CHILD WAS |
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_____ 1 Single |
______ 2 |
Twin |
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_____ 1 |
First |
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______ 2 |
Second |
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______ 3 |
Triplet. Etc. |
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______ 3 |
Others, Specify _____________ |
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c. BIRTH ORDER (live births and fetal deaths |
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d. WEIGHT AT BIRTH |
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including this delivery) |
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_____________ (first, second, third, etc.) |
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________________ grams |
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6. |
MAIDEN |
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(Last) |
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NAME |
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7. |
CITIZENSHIP |
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8. |
RELIGION |
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9a. |
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b. |
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c. No. of children |
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Total number of |
No. of Children still |
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children born |
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living including |
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born alive but |
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alive: _________ |
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this birth: _________ |
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are now dead: _________ |
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10. OCCUPATION |
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11. Age at the time |
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of this birth: |
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_______years |
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12. |
RESIDENCE (House No., Street, Barangay) |
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(City/Municipality) |
(Province) |
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13. |
NAME |
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(First) |
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(Middle) |
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(Last) |
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A |
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14. |
CITIZENSHIP |
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15. RELIGION |
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16. |
OCCUPATION |
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17. Age at the time |
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of this birth: |
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_______years |
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18.DATE AND PLACE OF MARRIAGE OF PARENTS (If not married, accomplish Affidavit of Acknowledgement/Admission of Paternity at the back.)
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19a. ATTENDANT
_____1 |
Physician |
______ 2 Nurse |
______ 3 Midwife |
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Hilot (traditional Midwife) |
______ 5 Others |
(Specify) |
_______________________________________________________________________________________________
19b. CERTIFICATION OF BIRTH
I hereby certify that I attended the birth of the child who was born alive at ______________o’clock
am/pm on the date stated above. |
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Signature ______________________________ |
Address ______________________________ |
Name in Print ___________________________ |
_____________________________________ |
Title or Position _________________________ |
Date _________________________________ |
_______________________________________________________________________________________________
20. INFORMANT
Signature ______________________________ |
Address ______________________________ |
Name in Print ___________________________ |
_____________________________________ |
Relationship to the child ___________________ |
Date ________________________________ |
_______________________________________________________________________________________________
21. PREPARED BY |
22. RECEIVED AT THE OFFICE OF |
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THE CIVIL REGISTRAR |
Signature ______________________________ |
Signature _____________________________ |
Name in Print ___________________________ |
Name in Print __________________________ |
Title or Position _________________________ |
Title or Position ________________________ |
Date __________________________________ |
Date _________________________________ |
_______________________________________________________________________________________________ |
FOR OCRG USE ONLY:
Population reference No.
TO BE FILLED UP AT THE OFFICE OF THE CIVIL REGISTRAR
41
48
4950
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64 |
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68 |
69 |
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70 |
72 |
74 |
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7679
86 87
8891
94
For this before 3 August 1988/on or after 3 August 1998
AFFIDAVIT OF ACKNOWLEDGEMENT/ADMISSION OF PATERNITY
Well, ___________________________________________________ and ____________________________________
parents/parent of the child mentioned in this Certificate of live Birth, do hereby solemnly swear |
that the information contained herein are true |
and correct to the best of our/my knowledge and belief. |
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_________________________________ |
_______________________________ |
(Signature of Father) |
(Signature of Mother) |
Community Tax No. _______________________ |
Community Tax No. _____________________ |
Date Issued _______________________________ |
Date Issued ____________________________ |
Place Issued ______________________________ |
Place Issued ____________________________ |
SUBSCRIBED AND SWORN to before me this ___________ day of ____________________________, _________________
at ___________________________________________________________________________________, Philippines.
_________________________________________ |
_______________________________________ |
(Signature of Administering Officer) |
(Title/Designation) |
_______________________________________________ |
___________________________________________ |
(Name in Print) |
(Address) |
Not applicable for births before 27 February 1931
AFFIDAVIT FOR DELAYED REGISTRATION OF BIRTH
(Either the person himself if 18 years old or over, or father/mother/guardian may accomplish this affidavit.)
I, ____________________________________________________________________, of legal age, single/married
and with residence and postal address at _____________________________________________________________________,
after having been duly sworn to in accordance with law, do hereby depose and say:
1.That I am the applicant for the delayed registration of my birth/of the birth of
_______________________________________________________.
2.That I/he/she was born on ____________________ at _____________________________________________.
3.That I/he/she was attended at birth by _______________________________________________who resides at
_____________________________________________________________________________.
4.That I/he/she is citizen of _________________________________________________________.
5. That my/his/her parents were |
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married on ____________________ at _______________________ |
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_______________________________________________. |
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not married but was acknowledge by my/his/her father whose |
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name is ________________________________________________. |
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6.That the reason for the delay in registering my/his/her birth was due to ________________________________
________________________________________________________________.
7.That a copy of my/his/her birth certificate is needed for the purpose of ________________________________
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8. |
(For the applicant only) That I am married to ________________________________________________. |
(For the father/mother/guardian) That I am the ________________________________ of the said person.
_________________________________________
(Signature of Affiant)
Community Tax No. ________________________
Date Issued _______________________________
Place Issued ______________________________
SUBSCRIBED AND SWORN to before me this _________ day of _______________________, ______________
at ____________________________________________________________________ _______________, Philippines.
________________________________________ |
_____________________________________ |
(Signature of Administering Officer) |
(Title/Designation) |
_________________________________________________ |
______________________________________________ |
(Name in Print) |
(Address) |