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Republic of the Philippines

National Capital Judicial Region


REGIONAL TRIAL COURT
Branch _______
Quezon City

EX SAMPLE,
Petitioner,


SP Case No. __________________
For: Change of Name

x--------------------------------------x

PETITION FOR CHANGE OF NAME


PETITIONER, thru counsel, unto this Honorable Court respectfully avers
that:

1. That the petitioner is of age, single, and a resident of No. 66
Matatag St. East Avenue, Quezon City;

2. That he has been a bonafide resident of Quezon City since the year
1974, or for at least three (3) years prior to the date of the filing of this petition;

3. That his present name is EX SAMPLE;

4. That such a name is ridiculous and has caused embarrassment to
petitioner through the years;

5. That petitioner requests that his present name be changed to ERIC
SAMPLE.


PRAYER

WHEREFORE, it is respectfully prayed that, after due notice, publication
and hearing in accordance with the Rules of Court, this Honorable Court
adjudge that the petitioners name of EX SAMPLE be changed to ERIC
SAMPLE, this 18
th
day of July 2014.


Law Firm of
__________________
& ASSOCIATES
___________________________
Tel. Nos. ___________________
Counsel for the Petitioner Ex Sample









By:

_______________________
__________________________________


VERIFICATION and CERTIFICATION

REPUBLIC OF THE PHILIPPINES )
CITY OF QUEZON ) S.S.


I, EX SAMPLE, Filipino, of legal age residing at No. 66 Matatag St., East
Avenue, Quezon City, after being sworn to in accordance with law, deposes and
says that:

1. I am the petitioner in the above-entitled case;

2. I have caused the preparation of the foregoing petition;

3. I have read the contents of the petition and they are true and correct
to the best of my own personal knowledge and based on authentic
documents; and

4. If I should learn that the same or similar action or claim has been filed
or is pending after its filing, I shall report that fact within five (5) days
from notice to the court or where the complaint or initiatory pleading
has been filed.

IN WITNESS WHEREOF, I hereby affixed my signature this 18
th
day of
July 2014 here in Quezon City, Philippines.


(Signed)
EX SAMPLE
Affiant


SUBSCRIBED and sworn to before me by affiant, this 18
th
day of July
2014, in the City of Quezon by EX SAMPLE with TIN ID No.
_______________________ issued on February 17, 2009 at Quezon City.


Doc. No. 226;
Page No. 65; ATTY. CHLOE ANNE V. SAN DIEGO
Book No. VII; Notary Public
Series of 2014.