Republic of the Philippines )

City of Cagayan de Oro ) S.S.

AFFIDAVIT

I, CRISTY S. LACIA, of legal age, single, Filipino, and a

resident of Block 3, Puntod, Cagayan de Oro City, after having been
duly sworn to in accordance with law, do hereby depose and say:

1. That I am not gainfully employed in any government

and/or private institution since reaching the age of reason
up to the present.
2. That I am now presently attending to care my children who
are all minors being a single mom.
3. That I execute this affidavit as to the truth of the foregoing
facts and in connection with my application to correct my
gender in my birth certificate.

IN WITNESS WHEREOF, I have hereunto affixed my signature

this 10th day of January, 2019, in the City of Cagayan de Oro,
Philippines.

CRISTY S. LACIA
Affiant

SUBSCRIBED AND SWORN TO before me this 10th day of

January, 2019 in the City of Cagayan de Oro, Philippines.

Doc No.
Page No.
Book No.
Series of 2019.