Republic of the Philippines

REGIONAL TRIAL COURT

FIRST JUDICIAL REGION
BRANCH 9
La Trinidad, Benguet

In re:
PETITION FOR ADOPTION OF SPECIAL PROCEEDINGS
MINOR HEIDI SUSANA PIMAN by CASE NO. 12345
SPOUSES MAKISIG AND MAYUMI
EDROZO, WITH CHANGE OF NAME FOR : ADOPTION

SPOUSES MAKISIG EDROZO AND

MAYUMI EDROZO,

Petitioners.
x------------------------------------------------x

PETITI O N

Petitioners, through undersigned counsel, and unto this most Honorable Court, allege
that:

1. The petitioners are Spouses MAKISIG EDROZO and MAYUMI EDROZO, both of legal
ages, Filipino Citizens, and residents of Km. 16 Asin Road, Tuba, Benguet, Philippines,
where they have established residence for more than three (3) years now and where they
may be served with summons and other Court processes. Petitioners were wed on
December 22, 1975 in Baguio City. They have 5 children namely: JAIME EDROZO,
RAPHAEL EDROZO, ELIZA EDROZO-MIGUEL, RUDY EDROZO and JOAN
EDROZO, who are all of legal ages. Machine copy of petitioners’ Marriage Certificate is
hereto attached as Annex “A”, to form part of this petition;

2. The Local Civil Registrar in the Municipality of La Trinidad, Benguet is a government

entity charged with the recording, registration, and custody of public records and other
matters, with postal address at La Trinidad Municipal Hall, La Trinidad, Benguet,
Philippines;

3. Petitioners desire to adopt SUSANA PIMAN, who was born on February 20, 2000 in
Dau, Mabalacat, Pampanga, to parents ROGELIO PIMAN and PURA PIMAN. The
adoptee has been under the petitioner’s care and custody since birth. A machine copy of
her Certificate of Live Birth is hereto attached as Annex “B”, to form an integral part
hereof;

4. Petitioners attest that they are in possession of full civil capacity and legal rights to adopt
the minor, SUSANA PIMAN. They possess all the qualifications, and none of the
 disqualifications for adopting said minor. They are both possessed of good moral
character; and have not been convicted of any crime involving moral turpitude;

5. They are likewise emotionally and psychologically capable of caring for said minor, and
are in a position to support and care for her;

6. They further attest that SUSANA PIMAN is not disqualified by law to be adopted, and
that to their knowledge she does not have any estate of value;

7. The natural mother of SUSANA PIMAN does not object and fully gives her consent to
this Adoption. She has executed her Affidavit of Consent hereto attached as Annex “C” to
form part hereof. SUSANA’s biological father is now deceased;

8. Affidavits of Consent of the Petitioners’ other children are hereto attached as Annexes
“D”, “E”, “F”, “G”, “H”, “I” and all attached to form an integral part hereof;

9. This adoption is for the best interests of SUSANA PIMAN.

PRAY E R

WHEREFORE, premises considered, it is most respectfully prayed of this Honorable

Court that:

1. After trial and hearing, the PETITIONERS’ prayer for adoption of minor SUSANA
PIMAN be granted;

2. Adoptee’s name be changed from SUSANA PIMAN to SUSANA EDROZO;

3. The Office of the Local Civil Registrar of La Trinidad be ordered to cancel the
birth certificate of SUSANA PIMAN, and to issue a new one for SUSANA
EDROZO, properly reflecting the entries in accordance with this adoption if so
granted.

Such other measures of relief as are just and equitable under the circumstances are
likewise prayed for.

Baguio City, for La Trinidad, Benguet, Philippines, 1 February 2014.

 ATTY. JOSELITO AGBUGGO
Counsel for Petitioners
Suites 501 & 504 JF Burnham Suites
Kisad Road, Baguio City
PTR No. 1050304; 1-05-14, Baguio City
IBP No. 580636; 1-05-10, Lifetime
Baguio-Benguet Chapter

REPUBLIC OF THE PHILIPPINES }

DONE: IN THE CITY OF BAGUIO } S.S.
X ========================== X

VERIFICATION AND CERTIFICATION

AGAINST FORUM SHOPPING

We, SPOUSES MAKISIG EDROZO AND MAYUMI EDROZO, the petitioners in

this case, have caused the preparation of the petition for adoption of a minor; we have read the
aterial and relevant allegations therein contained are true and correct of our personal knowledge.

We hereby certify that we have not heretofore commenced any action or filed any claim
involving the same issues before any other court, tribunal or quasi-judicial agency; that to the
best of our knowledge, there is no such pending action or claim and that if we should hereafter
learn that the same or similar action or claim has been filed or is pending, we shall report such
fact within five (5) days there from to the Honorable Court.

IN WITNESS WHEREOF, we have hereunto affix our signature this 1st day of February
2014, in the City of Baguio, Philippines.

MAKISIG EDROZO MAYUMI EDROZO

Affiant Affiant

SUBSCRIBED AND SWORN to before me in the City of Baguio this 1st day of February
2014 by Spouses MAKISIG AND MAYUMI EDROZO, personally known to me, who are the
same persons who personally signed before me the foregoing affidavit and acknowledged that
they executed the same.
JO-ANNE M. VENTIGAN
Notary Public
Until December 31, 2014
4F La Azotea Bldg., Session Road, Baguio City
Tel No.: (074)-442-3396
PTR No. 22222; 1/07/2014; Baguio City
IBP OR No: 7654321; 1/07/2014; Baguio City
Roll No.: 82112; 4/08/2004
Doc. No. __; Commission Serial No.: 74-NC-12 (R)
Page No. __; MCLE Compliance No.: IV-34458; 04/28/2014
Book No. I; TIN No: 802-112-107
Series of 2014