REPUBLIC OF THE PHILIPPINES

LOCAL CIVIL REGISTRY OFFICE

Province of Surigao del Sur
Municipality of Hinatuan

Republic of the Philippines)

Province of Surigao del Sur: SS
Municipality of Hinatuan)
Petition No. ______________

PETITION FOR CORRECTION OF CLERICAL ERROR

IN THE CERTIFICATE OF LIVE BIRTH

I, EMMA DUMALAGAN JABAGAT, filipino citizen, of legal age and a resident of P –

3 Barangay Maharlika, Hinatuan, Surigao del Sur, Philippines, after having been duly sworn to in
accordance with law, hereby declare that:

1. I am the petitioner seeking correction of the clerical error in the Certificate of birth of
TRIZIA CRISTINA MAE DUMALAGAN JABAGAT, who is my biological
daughter;

2. She was born on December 06, 1993 at Barangay Loyola, Hinatuan, Surigao del Sur,
Philippines;

3. The birth was recorded under registry number 93-00956;

4. The clerical error to be corrected are:

1.) Item No. 1 from TRIZIA CRISTINA MAE DUMALACAN to TRIZIA
CRISTINA MAE DUMALAGAN;
2.) Item No. 6 from EMMA TADLE DUMALACAN to EMMA TADLE
DUMALAGAN

5. The facts/reasons for filling this petition are the following:

a.) To conform to the correct spelling of the middle name of my daughter TRIZIA
CRISTINA MAE DUMALACAN to TRIZIA CRISTINA MAE DUMALAGAN and the maiden
family name of this petitioner, mother EMMA TADLE DUMALAGAN found in item No. 6 from
DUMALACAN to DUMALAGAN, viz:

6. I submit the following documents to support this petition: Certificate of Live Birth of
my daughter TRIZIA CRISTINA MAE DUMALAGAN JABAGAT as ANNEX “A” of this
petition; Certification issued by CLAIRE DENNIS S. MAPA, Ph. D., National Statistics and Civil
Registrar General of Philippine Statistics Authority dated November 07, 2019 marked as ANNEX
“B”; and Marriage Contract of herein petitioner and her husband FERNANDO S. JABAGAT, SR.,
as ANNEX “C”;

7. I have not filed any similar petition and that, to the best of my knowledge, no similar
petition is pending with any LCRO, Court or Philippine Consulate.

8. I am filing this petition at the LCR of Hinatuan, Surigao del Sur in accordance with RA
No. 9048 and its implementing rules and regulations.

EMMA D. JABAGAT
Petitioner
 VERIFICATION

I, EMMA D. JABAGAT, the petitioner, hereby certify that the allegations herein are true and
correct to the best of my knowledge and belief.

EMMA D. JABAGAT
Petitioner

SUBSCRIBED AND SWORN to before me this 30th day of January, 2020 at the Municipality of
Hinatuan, Surigao del Sur, Philippines, petitioner exhibiting her competent evidence of identity as
follows: Barangay ID No. 20190052 issued at Barangay Maharlika, Hinatuan, Surigao del Sur and
Comelec Voter ID VIN 6724-0034B-B1666EDJ20000-6.

ATTY. CANDELARIO J. VIOLA, JR.

Notary Public
Until December 31, 2021
Roll of Attorney No. 25215
PTR. No. 8356227 / January 7, 2020
` I.B.P. RECEIPT No. 085929 / May 20, 2019, Metro Manila

Doc. No. 439

Page No. 95
Book No. 1
Series of 2020
---------------------------------------------------------------------------------------------------------------------

ACTION TAKEN BY THE MCR

Granted Denied (Provide the basis for denial.)

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Date: _____________________ _____________________________

City / Municipal Civil Registrar
---------------------------------------------------------------------------------------------------------------------
For CRG use only
ACTION TAKEN BY THE CRG
Affirmed Impugned
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Date: ____________________________ ___________________________

Civil Registrar General

Payment of filing fee (Please attach copy of the official receipt.)

O.R. No. _____________
Amount Paid _____________
Date paid _____________