Republic of the Philippines )

City of Manila ) S.S.

AFFIDAVIT OF SERVICE

I, MICHELLE C. RIVERA, of legal age, single, Filipino citizen, and with place of
residence at 2424 Administration Site, Tala, Caloocan City, after being duly sworn to in
accordance with law, do hereby depose and state that:

I had personally served a copy of the Petition entitled: IN THE MATTER OF PETITION
FOR CANCELLATION OF THE CERTIFICATE OF LIVE BIRTH OF MARY ANN BERNARDO
CLEMENTE WITH REGISTRY NO. 2811-1071 vs. THE CITY CIVIL REGISTRAR AND ALL
PERSONS/ENTITIES WHO/WHICH MAY BE AFFECTED THEREBY docketed as S.P. Case No.
174-M-2018 in Branch 21 Regional Trial Court of Malolos, Bulacan, Affidavit of Publication
and the corresponding Judicial Affidavits of the witnesses to the following respondents
through registered mail with return card:

SAPP Anna Maria Angela V. Garcia Registry Receipt No. ___________

City Hall of Malolos, IBP Hall, Jacinto St. Date:
Malolos, Bulacan 3000

Local Civil Registrar of Malolos Registry Receipt No. ___________

Malolos City Hall, Jacinto Street, Date:
San Vicente, Malolos, Bulacan 3000

Office of the General Civil Registrar Registry Receipt No. ___________

3/F Vibal Bldg Times Street cor. EDSA, Date:
West Triangle, Quezon City

Philippine Statistics Office Registry Receipt No. ___________

PSA Complex, East Ave., Date:
Diliman, Quezon City

Office of the Solicitor General Registry Receipt No. ___________

134 Amorsolo St. Legaspi Village, Date:
Makati City

IN WITNESS WHEREOF, I have hereunto affixed my signature this ___________ day of

________________ in the City of ____________, Philippines.

MICHELLE C. RIVERA
Affiant

SUBSCRIBED AND SWORN to before me this _____________ of ________________ 2019 in

the City of ______________, Philippines, affiant exhibiting to me her ________________________.

NOTARY PUBLIC

Doc. No. ______;

Page No. ______;
Book No. ______;
Series of 2019.