REPUBLIC OF THE PHILIPPINES

PROVINCE OF ILOCOS SUR

MUNICIPALITY OF SINAIT

)
)

S.S

AFFIDAVIT OF CONSENT TO USE SURNMAME

I. CHARITY CASTILLO SABADO, 29 years old, a resident of Barangay Pug-os,
Sinait, Ilocos Sur 2733, after having duly sworn to in accordance with law, do hereby
declare that:
1.
I am seeking to use the surname YORO in the certificate of Live of Birth
if CRYSTAL FATE ALEYA SABADO YORO pursuant to R.A. 9255;
2.
CRYSTAL FAYE ALEYA SABADO YORO was born on June 22, 2016 at
Sinait, Ilocos Sur

No.

3.

The birth was recorded under Registrry No.

on

4.

The Affidavit of Admission of Paternity was recorded under Registry

on
art the Local Civil Registry office of Sinait, Ilocos Sur;

5.
I am filing this AUSF at the Local Civil Registry Office of Sinait, Ilocos
Sur, Philippines in accordance with R.A. No. 9255 and its Revised implementing
Rules and Regulations;
6.
I hereby certify that the statements made herein are true and correct
to the best of my knowledge and belief.
7.
IN WITNESS WHEREIOF, I hereby affix my signature on the 24 th day of
june, 2016 in the municipality of Sinait, Province of Ilocos Sur.

CHARITY CASTILLO SABADO

Affiant
VIN 2905-0078A-I1486CCS20000
Issued by COMELEC
At Cabugao, Ilocos Sur
SUBSCRIBED AND SWORN TO BEFORE ME this 24th day of June, 2016 at Sinait,
Ilocos Sur, Philippines, Affiant exhibiting to me her Identification Document
appearing immediately below her name and signature.