_________________________)

_________________________) Sc.
_________________________)
JOINT AFFIDAVIT OF CONSENT
WE, ALYXANDRIA NICOLE COUTURE, and WILHELM JULIUS
COUTURE, all of legal age, all with postal address at 2745 Burnham
Avenue, as !egas, "evada #.S.A., after having $een dul% sworn to in
accordance with law, here$% depose and state&
'. (hat we are the children of ")*+, )-.A ,"/-A+0
2. (hat our mother, ")*+, )-.A ,"/-A+, is a former 1ilipino
.iti2en and who is alread% married to 3*11-*4 SA+#* ,"/-A+0
5. (hat said spouses 3e6re% Samuel ,ngram and "oemi lorca
,ngram now wish to 7ointl% adopt )!*4 )-.A0
4. (hat we understand the e6ects of such adoption and here$%
give our consent to the same, as we honestl% $elieve that it will $e to
the $est interest of the child and will also $e $ene8cial to our mother0
5. (hat we are e9ecuting this a:davit to attest to the truth of the
foregoing statements and for whatever legal purpose this ma% serve.
," ;,("*SS ;<*-*)1, we have hereunto a:9ed our signatures
this _____ da% of __________________, 2='5 at
________________________________.
ALYXANDRIA NICOLE COUTURE WILHELM JULIUS
COUTURE
A:ant A:ant
S#BS.-,B*> A"> S;)-" (), $efore me this _______ da% of
_________________, 2='5 at ________________________________________.
_________________________)
_________________________) Sc.
_________________________)
AFFIDAVIT OF CONSENT
I, ANGELA RENEE INGRAM of legal age, with postal address at
2745 Burnham Avenue, as !egas, "evada #.S.A., after having $een
dul% sworn to in accordance with law, depose and sa%&
'. (hat , am a daughter of 3*11-*4 SA+#* ,"/-A+0
2. (hat m% father, 3*11-*4 SA+#* ,"/-A+ is a former 1ilipino
.iti2en and who is alread% married to ")*+, )-.A ,"/-A+0
5. (hat said spouses 3e6re% Samuel ,ngram and "oemi lorca
,ngram now wish to 7ointl% adopt )!*4 )-.A0
4. (hat , understand the e6ects of such adoption and here$% give
m% consent to the same, as , honestl% $elieve that it will $e to the $est
interest of the child and will also $e $ene8cial to m% father0
5. (hat , am e9ecuting this a:davit to attest to the truth of the
foregoing statements and for whatever legal purpose this ma% serve.
," ;,("*SS ;<*-*)1, , have hereunto a:9ed m% signature this
_____ da% of __________________, 2='5 at
________________________________.
ANGELA RENEE INGRAM
A:ant
S#BS.-,B*> A"> S;)-" (), $efore me this _______ da% of
_________________, 2='5 at ________________________________________.