Republic of the Philippines)

Province of Isabela ) S.S

Cauayan City

AFFIDAVIT

I, MAUREN NACION LICUDINI, of legal age, Filipino citizen and presently

residing at Pacific Heights, District !, Cauayan City, Isabela, after having been duly
sworn to in accordance with law, hereby depose and state THAT:

1. That I am married to ADONIS BAUTISTA MARAMAG on December 30, 2014

in Benito Soliven, Isabela.

2. That my name in your agency was MAUREN LICUDINI MARAMAG.

3. That I opted not to use the surname of my husband since the use of such will
be in conflict with all my other documents.

4. I state that MAUREN NACION LICUDINI and the MAUREN LICUDINI

MARAMAG is the name of one and the same person and that is myself.

I am executing this declaration to be submitted to the concerned authorities

for the change of name.

I hereby state that whatever is stated herein above are true to the best of my
knowledge.

IN WITNESS WHEREOF, I have hereunto set my hand this _________ day of

October 2018 in Cauayan City, Isabela, Philippines.

MAUREN NACION LICUDINI

Affiant

SUBSCRIBED AND SWORN to before me this ____ day of _____________

2019 at Cauayan City, Isabela.

Doc. No:_______
Page No:_______
Book No. _______
Series of 2019
Republic of the Philippines)
Province of Isabela ) S.S
Cauayan City

AFFIDAVIT

I, MAUREN NACION LICUDINI, of legal age, Filipino citizen and presently

residing at District II Benito Soliven, Isabela, after having been duly sworn to in
accordance with law, hereby depose and state THAT:

1. That I am married to ADONIS BAUTISTA MARAMAG on December 30, 2014

in Benito Soliven, Isabela.

2. That my name in your agency was MAUREN LICUDINI MARAMAG.

3. That I opted not to use the surname of my husband since the use of such will
be in conflict with all my other documents.

4. I state that MAUREN NACION LICUDINI and the MAUREN LICUDINI

MARAMAG is the name of one and the same person and that is myself.

I am executing this declaration to be submitted to the concerned authorities

for the change of name.

I hereby state that whatever is stated herein above are true to the best of my
knowledge.

IN WITNESS WHEREOF, I have hereunto set my hand this _________ day of

October 2018 in Cauayan City, Isabela, Philippines.

MAUREN NACION LICUDINI

Affiant

SUBSCRIBED AND SWORN to before me this ____ day of _____________

2019 at Cauayan City, Isabela.

Doc. No:_______
Page No:_______
Book No. _______
Series of 2019