Municipal Form 102 PDF Details

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.

QuestionAnswer
Form NameMunicipal Form 102
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other nameslive birth form, municipal form no 102, birth certificate form, birth certificate sample

Form Preview Example

Municipal Form No. 102

(To be accomplished in quadruplicate)

(Revised January 1993)

 

 

Republic of the Philippines

 

OFFICE OF THE CIVIL REGISTRAR GENERAL

 

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.)

 

Province _________________________________________

Registry No.

 

 

City/Municipality ___________________________________

 

 

 

 

 

 

 

 

 

 

REMARKS/ANNOTATION

 

1.

NAME

 

(First)

 

(Middle)

 

 

 

(Last)

 

 

 

 

 

 

 

 

 

 

 

 

2.

SEX

 

 

 

3. DATE OF BIRTH

(day) (month) (year)

 

______ 1 Male

_______ 2 Female

 

 

 

 

 

 

 

 

C

 

 

 

 

 

 

 

 

 

 

 

 

4.

PLACE OF

(Name of Hospital/Clinic/Institution/

(City/Municipality)

(Province)

H

 

BIRTH

House No., Street, Barangay)

 

 

 

 

 

 

I

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

L

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D

5a. TYPE OF BIRTH

 

 

b. IF MULTIPLE BIRTH, CHILD WAS

 

_____ 1 Single

______ 2

Twin

 

_____ 1

First

 

 

______ 2

Second

 

 

______ 3

Triplet. Etc.

 

 

______ 3

Others, Specify _____________

 

 

 

 

 

 

 

 

 

 

c. BIRTH ORDER (live births and fetal deaths

 

 

d. WEIGHT AT BIRTH

 

 

 

 

including this delivery)

 

 

 

 

 

 

 

_____________ (first, second, third, etc.)

 

 

 

________________ grams

 

 

 

 

 

 

 

 

 

 

 

 

6.

MAIDEN

 

(First)

 

(Middle)

 

 

 

(Last)

 

 

NAME

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7.

CITIZENSHIP

 

 

 

 

8.

RELIGION

 

M

 

 

 

 

 

 

 

 

 

 

 

 

O

9a.

 

 

b.

 

 

 

 

 

c. No. of children

T

Total number of

No. of Children still

 

 

 

children born

 

 

living including

 

 

 

 

born alive but

H

 

 

 

 

 

 

 

 

alive: _________

 

this birth: _________

 

 

 

are now dead: _________

E

 

 

 

 

 

 

 

 

 

 

 

 

10. OCCUPATION

 

 

 

 

 

 

11. Age at the time

R

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

of this birth:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

_______years

 

 

 

 

 

 

 

 

 

 

12.

RESIDENCE (House No., Street, Barangay)

 

(City/Municipality)

(Province)

 

 

 

 

 

 

 

 

 

 

 

 

13.

NAME

 

(First)

 

(Middle)

 

 

 

(Last)

F

 

 

 

 

 

 

 

 

 

 

 

 

A

 

 

 

 

 

 

 

 

 

 

 

 

14.

CITIZENSHIP

 

 

 

 

 

 

15. RELIGION

T

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

H

 

 

 

 

 

 

 

 

 

 

 

 

E

 

 

 

 

 

 

 

 

 

 

 

 

16.

OCCUPATION

 

 

 

 

 

 

 

17. Age at the time

R

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

of this birth:

 

 

 

 

 

 

 

 

 

 

 

 

_______years

 

 

 

 

 

 

 

 

 

 

 

 

 

18.DATE AND PLACE OF MARRIAGE OF PARENTS (If not married, accomplish Affidavit of Acknowledgement/Admission of Paternity at the back.)

_______________________________________________________________________________________________

19a. ATTENDANT

_____1

Physician

______ 2 Nurse

______ 3 Midwife

_____4

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.

 

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

 

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

62

64

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

68

69

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

70

72

74

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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.

 

_________________________________

_______________________________

(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

 

married on ____________________ at _______________________

 

 

_______________________________________________.

 

 

 

 

not married but was acknowledge by my/his/her father whose

 

 

 

 

name is ________________________________________________.

 

 

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 ________________________________

 

________________________________________________________________.

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)

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