Republic of the Philippines)

: s.s.
City of Butuan . . . . . . . . )
X----------------/

AFFIDAVIT OF LATE REGISTRATION OF

BIRTH WITH CORROBORATION

WE, ____________________________and __________________________ both of legal age,

and residents of _______________________Butuan City, after having been duly sworn to in
accordance with law do hereby depose and say;

1. That we are the parents of ______________________________, who was born out

of wedlock on ______________________, at Butuan City Medical Center, Butuan
City;

2. That the birth of our child was assisted by Dr._____________________, Medical

Officer III thereat;

3. That our child was not yet baptized as he still has no birth certificate which is
one the requirements for baptism;

3. That we are not yet married up to this time;

4. That due to financial and time constraints, we failed to register the birth of
our
child with the City Civil Registrars Office of Butuan City;

5. That we are executing this affidavit to attest to the truthfulness of the

foregoing statements and in support of our application for the late
registration of the birth of our child, ___________________________________, with
the Local Civil Registrar of Butuan City.

IN WITNESS WHEREOF, WE have hereunto set our hands this 26th day of July
2012 at Butuan City, Philippines.

VLADIMER L. RADAZA MONICA S. NAMANAS

Affiant Affiant
CTC No. 00802094 CTC No. 00802093
Issued on 7/26/2012 Issued on 7/26/2012
Issued at, Butuan City Issued at Butuan City

CORROBORATION

WE, CHRISTIAN M. DELIGERO and CHARLES M. PALEN, both of legal age

single, Filipino and residents of Village II, Libertad, Butuan City, respectively, under oath
and say: That we personally know PRECIOUS AMHEY NAMANAS RADAZA, who was
born out of wedlock to _______________ and ________________on December 28, 2011 at
the Butuan City Medical Center, Butuan City; that due to time and financial constraints,
her birth was not registered by her parents with the LCR of Butuan City; that we are
executing this affidavit in order to attest to the truthfulness of the foregoing facts.

CHRISTIAN M. DELIGERO CHARLES M. PALEN

Affiant Affiant
Com. Tax Cert. Com. Tax Cert. No. 00782746
Issued on 07/26/2012 Issued on 05/30/12
Issued at Kitcharao, Agusan del Issued at Nasipit, Agusan del Norte

SUBSCRIBED AND SWORN TO, before me this 26th day of July 2012 Butuan
City, Philippines. Affiants exhibited to me their Community Tax Certificates which are
indicated right below their respective names.

JASMIN D. BERAY-CACHAPERO
Public Attorney III
(Pursuant to R.A. 9406)