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PROVINCE OF LAGUNA)
MUNICIPALITY OF CALAUAN ) S. S.
We, JOSE ANTONIO DIAZ, married, of legal age, Filipino and presently residing at Brgy.
Balayhangin, Calauan, Laguna and VIEL RAMOS MARANAN, single, of legal age, Filipino,
presently residing at Brgy. Lamot 1, Calauan, Laguna, both after having duly sworn to in
accordance with law, depose and state:
2. That said ARNOLD DOMEGELLIS BUSTARGA was born on JULY 21, 1987 at San
Jose, Bula Camarines Sur, to his parents ROSALINDA BEDRIJO DOMEGELLIS
(mother) and ROMEO DULFO BUSTARGA (father) ;
3. That in the records of his birth that are used in other legal/important documents his
birthdate was erroneously indicated as June 15, 1987 instead of JULY 21, 1987;
5. That We have prepared this statement to attest to the truth hereof and to support the
correction of entries on his other important documents/records as we know said person as
we are close acquaintances of the family although we are disinterested persons in his
case;
IN WITNESS WHEREOF, We have hereunto affixed our signatures this 2nd day of
December 2019 at Calauan, Laguna.
SUBSCRIBED AND SWORN to before me a Notary Public for the Municipality of Calauan,
Bay, Los Banos and in the City of Calamba Laguna with office address at 2/F, Villaran Building,
Alvela St., Brgy. Kanluran Calauan Laguna, this 2nd day of December 2019 personally appeared
the above named affiant showing to me their ID and avows under penalty of law to the whole
truth of the contents thereof.