FORM NO. 8.

AFFIDAVIT OF DISCREPANCY
(SURNAME/FAMILY NAME)

Affidavit of Discrepancy of Family Name

REPUBLIC OF THE PHILIPPINES)

CITY OF BAGUIO ) S.S.

I, JAYSON L. MILBY, of legal age, Filipino, single and a

resident of #64 Naguilian road, Baguio City, Philippines,
under oath state that:

1. I was born on 19th day of the September 1960 to

spouses Lea Derma and Joe Milby;

2. I have been using the name JAYSON L. MILBY in all

my documents and transactions;

3. However, when I obtained a copy of my birth

certificate, I discovered that my surname appearing
thereon was erroneously written as "MELBY";

4. The names JAYSON L. MILBY and JAYSON L. MELBY

refers to one and the same person;

5. I execute this Affidavit of Discrepancy of Surname to

attest to the truth of the foregoing facts and to explain
the discrepancy in my birth certificate with regard
my surname.

IN WITNESS WHEREOF, I have hereunto affix my

signature this20th day of January, 2017 in the City of Baguio,
Philippines.

Jayson L. Milby
(Signature
of Affiant)

SUBCRIBED and sworn to before me, this 20th day of

January 2017, in the City of Baguio, Philippines, by Jayson L.
Milby exhibiting to me his Dives License with no. LO-40-
675438 issued on January 8, 2015 at Baguio City,
Philippines.

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Doc. No. _8___;
ATTY. DENVER A.
Page No. _5___;
GAMLOSEN
Book No. __2__;
Series of NOTARY
2017 . NOTARY PUBLIC
Commission Serial No. 105
PUBLIC
Until December 31, 2017
ROLL NO. Roll No. 10987
P.T.R. No. 0007, 1/4/2017,
BAGUIO CITY,
Baguio.
PHILIPPINES
IBP No. 0003, 1/9/2017,
Baguio.
MCLE Compliance No. 1234

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