Republic of the Philippines)

City of Borongan) S.S.

AFFIDAVIT OF OUT OF TOWN

LATE REGISTRATION OF BIRTH

I, HELEN CILLO BUENO, of legal age, Filipino, married, and a resident of

Brgy. Surok, Borongan City, Eastern Samar, after having duly sworn to in accordance
with law hereby depose and state that:

1. I am applying for an out of town late registration of my birth before the Local
Civil Registrar of Borongan City;

2. I was born on October 30, 1987 at Brgy. Dinigpian, Dolores, Eastern Samar,
and my parents were EDITHA CILLO (mother) and ANTONIO P. BUENO
(father);

3. The foregoing facts of birth was not recorded in the civil register of Dolores,
Eastern Samar because of the inadvertence and negligence of my parents;

4. I am seeking to record my birth in Borongan City as I have been residing here

for almost twenty-years already and my residence is in Brgy. Surok, Borongan
City, and that registering my birth in Dolores, Eastern Samar, would be
impractical, tedious and costly due to distance;

5. I am also applying for the late registration of my birth and threason for the delay
of my birth registration was also due to the inadvertence and negligence of my
parents;

6. I am executing this affidavit to attest to the veracity of the foregoing facts and
for whatever legal purposes this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 16th day of

September 2019 at Borongan City, Eastern Samar.

HELEN CILLO BUENO

Affiant

SUBSCRIBED AND SWORN to before me this 16th day of September 2019 at

Borongan City, Eastern Samar, affiant showing me her VIN 2604-0113A-
J3087HCB20000 as proof of her identity.

Doc. No. ___ Atty. FERNANDO L. TANGLAO, JR.

Page No. __; Notary Public
Book No. ___; Commission Expires on December 31, 2019
Series of 2019. Commission No. 02-11-2018
PTR No. 3553910/ January 4, 2018/ Borongan City
IBP No.: 1037958/ CY 2018/ Eastern Samar
MCLE Compliance No.: V-0021212
Roll No.: 60002