Republic of the Philippines

7th JUDICIAL REGION

Regional Trial Court
Branch ____, Mandaue City

SPOUSES SHELDON JOSEPH F. CABUA

and MARY FIEL ICOT,
Petitioners,
SP PROC. No. _________
For Domestic Adoption of a Minor
x ------------------------------------ x

PETITION FOR DOMESTIC ADOPTION OF MINOR

The petitioners, through the undersigned attorney, and unto this Honorable
Court, respectfully avers that:

1. The petitioners, Spouses Sheldon Joseph F. Cabua and Mary Fiel Icot are husband
and wife, Filipinos, both of age, and residents of #646 Kawayanan, Yati, Liloan,
Cebu. Marriage Certificate

2. They have one (1) legitimate child, now 17 years old, who has given her consent to
the adoption (Affidavit of Consent), and hereby desire to jointly adopt a minor
foundling named ANGEL MARIE I. CABUA, 2 years & 7 months old, a copy of the
Certificate of Foundling is hereto attached as Annex “A”;

3. The Department of Social Welfare and Development has issued a certification that
the child Angel Marie I. Cabua is legally available for adoption pursuant to Republic
Act No. 9523, evidenced by a Certification of a Child Legally Available for Adoption,
hereto attached as Annex “B”;

4. The Department of Social Welfare and Development, through its Undersecretary of

Operations and Programs Group (OPG), Parisya H. Taradji, has issued an Affidavit of
Consent To Adoption, a copy of the Affidavit of Consent To Adoption is hereto
attached as Annex “C”;

5. Petitioners are qualified to adopt the minor and have complied with the
requirements under the Domestic Adoption Act of 1998 (R.A. No. 8552) and Articles
183 & 184 of the Family Code of the Philippines, EO 20 and the Adoption Policy of
the DSWD;

6. Petitioners will be able to financially and morally bring up and educate the said
minor properly and adequately, as they are both gainfully and regularly employed
and of good moral standing in the community. (Income tax Return; Character
 references from non-relative members of the immediate community, Police
Clearance, NBI Clearance and Barangay Clearance)

WHEREFORE, it is respectfully prayed that judgment be rendered in petitioners’ favor

adjudging the minor child Angel Marie I. Cabua freed from all legal obligations of obedience and
maintenance with respect to her natural parents and that she be declared to all legal intents
and purposes, the child of herein petitioners and that her name be ANGEL MARIE I. CABUA.

Mandaue City, Cebu. May 21, 2015.

THELMA L. JORDAN
Counsel for the Petitioners
ROLL NO. 29577
Cebu North Road, Poblacion
6002 Liloan, Cebu
Tele/fax No. 564-2660
PTR No. 7407554, 01/05/2015, Liloan, Cebu
IBP No. 961562, 12/03/2014 Cebu Province
MCLE Compliance No. IV-0023723
07/03/2014, MCLE Supreme Court
 VERIFICATION & CERTIFICATION AGAINST FORUM SHOPPING

We, SPOUSES SHELDON JOSEPH F. CABUA and MARY FIEL ICOT, both Filipinos,
of legal ages, and residents of No. 646 Kawayanan, Yati, Liloan, Cebu, do hereby state that: we
are the PETITIONERS in the document entitled PETITION FOR DOMESTIC ADOPTION OF
MINOR being verified and in such capacity, caused this petition to be prepared;

We have read its contents and affirm that they are true and correct to the best of our own
personal knowledge; We hereby certify that there is no other case commenced or pending before
any court involving the same parties and the same issue and that, should we learn of such a case,
we shall notify the court within five (5) days from my notice.

IN WITNESS WHEREOF, we have signed this instrument on ______________ in

Liloan, Cebu, Philippines.

SPS. SHELDON JOSEPH F. CABUA and MARY FIEL ICOT

AFFIANTS

SUBSCRIBED AND SWORN TO before me in Liloan, Cebu, Philippines, on this

_______________, affiants exhibiting before me their Government Issued Identifications to wit:
================================================================
SHELDON JOSEPH F. CABUA PRC ID No. E2-0035087 exp. 10/04/2019
MARY FIEL ICOT SSS-UMID CRN-006-0101-5061-4
================================================================

NOTARY PUBLIC
Until December 31, 2016

Doc. No. ________;

Page No. ________;
Book No. _______;
Series of 2015.