RA 9048/R.A. 10172 Form No. 1.

1(LCRO)
(Devised 10 October 2001)

Republic of the Philippines

Local Civil Registry Office
Province Aklan
City/Municipality Altavas

Republic of the Philippines ) Petition No. _________________________

Altavas, Aklan )SS

PETITION FOR CORRECTION OF CLERICAL ERROR

IN THE CERTIFICATE OF LIVE BIRTH

I, , of legal age,
(complete name of petitioner) (Nationality/citizenship)
and a resident of
(complete address)
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:

a) my Certificate of live Birth
b) the Certificate of Live Birth of
(complete name of owner)
who is my
(relation of owner to the petitioner)
2) I/He/She was born on , at ,
(date of birth) (city/municipality)
, .
(province) (country)
3) The birth was recorded under registry number .

4) The clerical error to be corrected is:

a) Item No.
b) Description:
c) From:
d) To:

5) The facts/reason for filing this petition are following:(Use additional sheets,if necessary.)

6) I submit the following documents to support this petition:( Use additional sheets, if nessary.)
a)
b)
c)
d)

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

8) I am filing this petition at the LCRO of Altavas , Aklan

(city/municipality) (province)
in accordance with R.A. 9048 and its implementing rules and regulations.

Signature over printed name of petitioner

VERIFICATION

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

Signature over printed name of petitioner

SUBSCRIBED AND SWORN to before me this ______ day of in the city/municipality

of , petitioner exhibiting his Community Tax Certificate No. issued at
on .

Administering Officer

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

For C/MCR use only

X ACTION TAKEN BY THE C/MCR

(Provide the basis for the action taken.)
Granted / / Denied

Date:
Municipal Civil Registrar
 ACTION TAKEN BY THE CRG
(Provide the basis for the action taken .)
/ / Affirmed / / Impugned

Date:
Civil Registrar General

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

O.R. No.
Amount Paid
Date Paid
the corrrect
municipality