A 9255 FORM No.

1
(Devised May 2004)

REPUBLIC OF THE PHILIPPINES )

PROVINCE OF NUEVA VIZCAYA ) S.S.
MUNICIPALITY OF ARITAO )

Registry No._____

AFFIDAVIT TO USE THE SURNAME OF THE FATHER

I, JAYN-B C. SINULDONG, of legal age, Filipino Citizen, single and a

resident of Poblacion, Aritao, Nueva Vizcaya under oath declare that:

1. I am seeking the change of surname in the Certificate of Live Birth

of JAEGERNET MILLEN MACLANG who is my son;

2. He was born on February 18, 2000 in Poblacion, Aritao, Nueva

Vizcaya, Philippines;

3. The birth was recorded under registry no. 2000-149;

4. The surname to be changed is from MACLANG TO SINULDONG

pursuant to RA 9255;

5. I am filing this affidavit at the LCRO of Aritao, Nueva Vizcaya in

accordance with RA 9255 and its implementing Rules &
Regulations;

6. I hereby certify that the statements made herein are true and correct
to the best of my knowledge and belief.

In truth whereof, I have hereunto affixed my signature this 18th day of

September 2009.

JAYN-B C. SINULDONG
Affiant

SUBSCRIBED AND SWORN to before me this 18th day of September 2009

at Aritao, Nueva Vizcaya.

LUCITA “LUCING” L. TAN

Mayor
Register No. _______

Republic of the Philippines )

Province of Nueva Vizcaya ) S,S,
Municipality of Aritao )

AFFIDAVIT OF ACKNOWLEDGEMENT

I, ALFREDO O. LEPROZO, of legal age, Filipino Citizen and a resident

of Kirang, Aritao, Nueva Vizcaya, under oath declare that:

1. I am the natural father of Jhade Aubrey Gaoiran, who was born in

Kirang, Aritao, Nueva Vizcaya on February 24, 2006;

2. Her mother is Cherry Ann S. Gaoiran whom I lived with as my

lawful wife;

3. I am executing this affidavit to attest to the truth of the foregoing

statements & purposes of acknowledging my child.

In truth whereof, I have hereunto affixed my signature this 9th

day of May 2008.

ALFREDO O. LEPROZO
Affiant

SUBSCRIBED AND SWORN to before me this 9th day of May

2008 at Aritao, Nueva Vizcaya.

LUCITA “LUCING” L. TAN

Mayor