REPUBLIC OF THE PHILIPPINES

REGIONAL TRIAL COURT

FOURTH JUDICIAL REGION
Branch ________
Dasmarias, Cavite

IN THE MATTER OF CANCELLATION/

CORRECTION OF ENTRIES IN THE
CERTIFICATE OF LIVE BIRTH OF
KIYUKO C. TERAUCHI

PINKY ABRERA CANDELARIA

Petitioner,

---versus--- Special Proc. No. _________

CIVIL REGISTRAR OF DASMARIAS,

CAVITE AND ALL PERSONS/ENTITIES
WHO/WHICH MAY BE AFFECTED THEREBY,
Respondents.

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

PETITION

Petitioner, through the undersigned counsel and to this

Honorable Court, most respectfully states that:

1. Petitioner is of legal age, Filipino, single, a resident of Blk.

1 Lot 27 Millwood Ville Pulo, Cabuyao, Laguna and the mother and
guardian of her minor child KIYUKO CANDELARIA TERAUCHI;
whereas Respondent - Civil Registrars are public officers in-charge of
the registration and cancellation/correction of entries in the civil
registrar where the fact of birth of the said minor child was registered,
which registrar is located at Ground Floor, City Hall, City of
Dasmarias;

2. Petitioner conceived and gave birth to her child KIYUKO

CANDELARIA TERAUCHI on November 13, 1995 at De La Salle
University Medical Center, Dasmarias, Cavite, out of wedlock with
Kazuya Terauchi, which fact of birth was registered on November 17,
1995 before the Office of Respondent Civil Registrar of Dasmarias,
Cavite under Civil Registry No. 95-8418. Copy of the Certificate of Live
Birth of Kiyuko C. Terauchi is hereto attached as Annex A;

3. Prompted by the misbelief that her child, being born out of

wedlock, could not utilize the surname of her father Kazuya Terauchi,
and that it is more convenient and easy to process the registration of
her childs birth if she was married with Kazuya. Petitioner supplied
erroneous information as regards the date and place of her marriage
with Kazuya Terauchi;

5. Petitioner misrepresented in her application for the

registration of birth of her child that she and Kazuya Terauchi were
married on June 20, 1994 in Japan, when the truth of the matter is
that they were and have not been married to this date. Copy of the
Certification issued by the Civil Registrar General attesting to the fact
that Petitioner has not been married to Kazuya Terauchi as their
marriage does not appear in the National Indices of Marriage is hereto
attached as Annex B;

6. As a result, Entry No. 18 referring to the date and

place of marriage of the parents of the said minor child, and
consequently, Entry No. 20 particularly the printed name of herein
Petitioner which was entered as PINKY TERAUCHI, instead of PINKY
A. CANDELARIA, of Certificate of Live Birth of the child are false and
misleading. Entry No. 18 in Annex A is hereto bracketed and marked
as Annex A-1. While, Entry No. 20 in Annex A is further bracketed
and marked as Annexes A-2;

7. In order to correct the aforementioned misinformation and

erroneous entries in the Certificates of Live Birth of her minor child,
Petitioner hereto files the instant Petition pursuant to Rule 108 of the
Revised Rules of Court;
 8. Kazuya Terauchi, the father of the above-named child, who
has been permanently residing in Japan did not acknowledge nor
admit paternity over the said child as he did not sign the Letter of
Acknowledgment in the Certificate of Live Birth of Kiyuko.

PRAYER

WHEREFORE, premises considered, it is most respectfully prayed

to this Honorable Court that an Order be issued directing the herein
Respondent Civil Registrars to cancel the information supplied as
the date and place of marriage of parents in Entry No. 18 and to
correct Entry No. 20, particularly the printed name of the herein
Petitioner from PINKY TERAUCHI to PINKY CANDELARIA and to
correct the surname of the minor child from KIYUKO CANDELARIA
TERAUCHI to KIYUKO CANDELARIA in the Certificate of Live Birth of
her minor child Kiyuko.

Other reliefs just and equitable are likewise prayed for.

Cabuyao City for Dasmarias City. April __________, 2013.

ATTY. NESTOR A. LOABLE

Counsel for the Petitioner
216 Banlic, Cabuyao City, Laguna, Philippines
PTR No. 0036913/Jan. 3, 2013/Cabuyao City
IBP NO. 907365/Jan. 3, 2013/Laguna Chapter
Attorneys Roll No. 59142/MCLE Compliance IV-0010420

REPUBLIC OF THE PHILIPPINES)

CITY OF CABUYAO )SS

VERIFICATION AND CERTIFICATION

AGAINST FORUM-SHOPPING

I, PINKY CANDELARIA-NAKAYAMA, married, of legal age, Filipino

and a resident of Blk. 1 Lot 28 Millwood Ville, Pulo, Cabuyao, Laguna,
after having been duly sworn to in accordance with law, do hereby
depose and state that:
 1. I am the Petitioner in the foregoing Petition and I have
caused the preparation of the same, the contents of which are all true
and correct to the best of my personal knowledge, information and
belief;

2. I certify that neither have I commenced nor is there any

pending Petition of similar nature before any court, tribunal or quasi-
judicial agency, and if I should hereafter learn that the same or similar
Petition has been filed or is pending in any court, tribunal or quasi-
judicial agency, I shall report the fact within five (5) days therefrom to
this Honorable Court.

IN WITNESS WHEREOF, I have hereunto set my hand this

____________ day of April, 2013 in Cabuyao City.

PINKY CANDELARIA-NAKAYAMA
Affiant

SUBSCRIBED AND SWORN to before this ______ day of ________________,

20___ at _____________________________.

NOTARY PUBLIC

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of _____;