REPUBLIC OF THE PHILIPPINES ]

PROVINCE OF DAVAO DEL SUR ]

CITY OF DIGOS ] S.S.
X - - - - - - - - - - - - - - - - - - - - -/

AFFIDAVIT TO USE THE SURNAME OF THE FATHER

I, Jaynies D. Brion, of legal age, Filipino, with postal and

residence address at # 290 Brgy. Zone 2, Digos City, Davao
del Sur, after having been duly sworn to in accordance with
law hereby depose and say:

1. That I am the biological father of Cyrene;

2. That the biological mother of my child is Cheryll G.

Maghirang;

3. That my child Cyrene was born on June 28, 2010 in

Digos city;

4. That I, Jaynies D. Brion, being the father of Cyrene

hereby acknowledge and recognize her as my child and
legal heir;

5. That I am allowing my child Cyrene to use my surname,

Brion to be her surname and shall be known as Cyrene
M. Brion.

6. That I am executing this affidavit to attest to the truth

and veracity of the foregoing facts and for whatever
legal intents and purpose it may serve, in compliance
with the provision of Republic Act No. 9255.

IN WITNESS WHEREOF, we have hereunto set our

hands this 9th of January 2017 at Digos City, Philippines.

Conforme:

_________________________
_________________________
 Cheryll G. Maghirang Jaynies
D. Brion
Mother
Affiant/Father

Subscribed and sworn to before me this 9th of

January 2017 at Digos City Philippines. Affiants exhibited to
me their Valid Identification Nos. as above indicated.

JAMES L. DECOLONGON
Notary Public
Doc No. ____ Until December 31, 2017
Page No. ____ Roll No.: 82714
Book No. ____ IBP No. 631820, January 6, 2014, Digos
City
Series of 2017 PTR No.080324 January 6, 2014 Digos
City TIN: 290-937-407 January
6, 2010 Digos City