REPUBLIC OF THE PHILIPPINES)

SANTIAGO CITY ) S.S. 

x--------------------------x
                                                      
AFFIDAVIT OF LATE REGISTRATION OF BIRTH

 I, MARIA A. LABO, of legal age, Filipino, single and a resident of 412

Arranz St. Dubinan East, Santiago City, Isabela after having been duly sworn
to in accordance with law, depose and state:

1. That I am the mother of JOSE A. LABO who was born on January 15,
2015 at Santiago City;

2. That I did not register said child because I suffered a mental health
condition when I delivered him; and

3. That I am executing this affidavit for the purpose of registering the birth
certificate of said child at the civil registry of Santiago City;

         IN WITNESS WHEREOF, I have hereunto set my hand this 22nd day of

March 2021 in Santiago City, Philippines.
          
MARIA A. LABO
Affiant
Voter's ID No. 5522      
      
          SUBSCRIBED AND SWORN to before me, this 22 nd day of March, 2021
in Santiago City, with affiant exhibiting his Voter's ID No. 5522, Issued on
January 21, 2013 at Santiago City.
 
 
                                                                                  ATTY. JUAN A. DELA CRUZ
   NOTARY PUBLIC
                                                                                          Until December 31, 2021

Doc.  No. :  ________;

Page  No. :  ________;
Book No. :  ________;
Series of 20_______.

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