REPUBLIC OF THE PHILIPPINES )

MUNICIPALITY OF CAMILING
) S.S
PROVINCE OF TARLAC
)

AFFIDAVIT OF DISREPANCY
I, JOSEPHINE GARCIA y DELA CRUZ, of legal age, Filipino citizen, widow,
and a resident of Paterno St., Poblacion E, Camiling, Tarlac, Philippines, after having
been duly sworn to in accordance with law, do hereby depose and state THAT:
1. When I entered school and until I got married to Alfonso Garcia, I
consistently used JOSIPIN as my First Name. Hence, my Marriage
Contract bears such first name. Machine copies of my Certificate of Birth
and Marriage Contract are hereto attached as Annexes A and B;
2. After my marriage, I have been using JOSEPHINE as my first name in my
other transactions and identification cards (Senior Citizen ID card and
Voter ID card);
3. I am executing this Affidavit to attest to the fact that the names JOSIPIN
DELA CRUZ, appearing in the above-said Certificate of Birth and Marriage
Contract, and JOSEPHINE C. GARCIA or JOSEPHINE DELA CRUZ
GARCIA, as recorded in my other transactions and identification cards,
refer to one and the same person, and that is me;
4. Finally, I am executing this affidavit to attest to the truth of the foregoing
statements and for whatever legal purposes and intents this may serve.
IN WITNESS WHEREOF, I have hereunto affixed my signature this 2 nd day of
December, 2015 at Camiling, Tarlac, Philippines.
JOSEPHINE DELA CRUZ GARCIA
Affiant
SUBSCRIBED AND SWORN to before me on the date and place indicated
above. Affiant exhibited before me her Senior Citizen Card with Control No. 1055
issued by the Office of the Senior Citizens Affairs (OSCA), Camiling, Tarlac.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2015