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

1(LCRO)
(Modified 7 January 2013)

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 MARRIAGE

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 Marriage entered into with
(complete name of spouse)

b) the Certificate of Marriage of

(complete name of husband or wife)

who is my
(relation of owner to the petitioner)
2) I/He/She contracted marriage on , at
(city/municipality)
(date of marriage)
,
(province) (country)

3) The marriage 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/reasons 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 ,______________________________

(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

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
__________
____ issued