Republic of the Philippines] Santa Cruz, Laguna ] s.s.
I MARIZEL SALE BERNALES, of legal age, Filipino, married and resident of Sitio 2, Brgy, Bagumbayan, Santa Cruz, Laguna after having been sworn in accordance with law, hereby depose and state that – that – 1.
In my official records and identification cards at the Social Security System (SSS), Bureau of Internal Revenue (BIR), and Land Transportation Office (LTO), the spelling of my name appears as “MARIZEL SALE BERNALES”. BERNALES” . On the other hand, in my Certificate of Live Birth, my name is spelled as “MARIZELLE ISLES SALE”.
2.
The person named “MARIZEL SALE BERNALES” BERNALES” in SSS Id. No. 04315222-4, BIR T.I.N. Id. 113-941-658-000, and Driver’s Dri ver’s License No. D12-05D12 -05003491 on one hand; and the person named “MARIZELLE ISLES SALE” SALE ” in the attached Certificate of Live Birth refer to one and the same person: I,“MARIZEL SALE BERNALES” the BERNALES” the undersigned affiant, married Edwin B. Bernales.
3.
Moreover, in my Certificate of Live Birth, the place of of my birth was erroneously recorded as “LUCNA”, when in truth and in fact, I was bo rn in “LUCENA”. Manifestly on Manifestly on the face of the certificate, this was a clerical error on the part of the person who recorded the entries in my Certificate of Live Birth. To set the record straight, I was born in Lucena City in Quezon Province.
IN WITNESS WHEREFORE, I hereto affixed my signature this 17 th day of September 2016 in Santa Cruz, Laguna. MARIZEL SALE BERNALES
Affiant SUBSCRIBED AND SWORN to before me this 17 th day of September 2016 by the affiant who exhibited to me her above-mentioned identification cards and birth record. WITNESS MY HAND AND NOTARIAL SEAL this 17 th day of September 2016 in Santa Cruz, Laguna.
Doc. No. _____; Page No._____; Book No._____; Series of 2016.
ATTY. EMMANUEL E. SANDICHO
NOTARY PUBLIC, COMMISSION UNTIL 31 DEC. 2016 NOTARY PUBLIC FOR THE PROVINCE OF LAGUNA PER NOTARIAL COMMISSION SP. PROC. NO. 164(15) IBP O.R. No. 995689, 04 January 2016, Laguna Chapter PTR O.R. No. 2967138, 04 January 2016, Laguna Roll No. 42246, admitted to practice law on 9 May 1997 MCLE Compliance No. V-0015412, dated 6 March 2016
