REPUBLIC OF THE PHILIPPINES)

PROVINCE OF BULACAN :S.S.

CITY OF MALOLOS )

AFFIDAVIT
Re: Change Status

I, MARIA CORAZON PAGDANGANAN REYES, of legal age, married to

JAZTHIN CANTILLAN REYES, Filipino and a resident of Iba O Este, Calumpit,
Bulacan, after having been duly sworn to in accordance with law hereby voluntarily
depose and say that:

1. I am an employee of the Provincial Government of Bulacan assigned at the

Provincial Social Welfare Development Office as Community Affairs Officer II;

2. That I am requesting to change my name as appearing on my records at the

Human Resource and Management Office from MARIA CORAZON
PAGDANGANAN to MARIA CORAZON PAGDANGANAN REYES being married
to JAZTHIN CANTILLAN REYES;

3. That hereto attached is a xerox copy of our Certificate of Marriage, solemnized

before Rev. Fr. Jose Luis DR. Perez, Officiating Priest on July 29, 2017 at St. John The
Baptist Parish at Poblacion, Calumpit, Bulacan;

4. Having already been married, I used the name MARIA CORAZON

PAGDANGANAN REYES after my marriage;

5. I am executing this affidavit to attest to the veracity of the foregoing statements

and to request the authorities concerned to cause the necessary change in my name in my
appointment papers and other official records from MARIA CORAZON
PAGDANGANAN to MARIA CORAZON PAGDANGANAN REYES.

FURHTERMORE, I SAYETH NONE.

MARIA CORAZON PAGDANGANAN REYES

Affiant

SUBSCRIBED AND SWORN to before me this 30 th day of October 2018, at

Malolos City, Bulacan. Affiant exhibited to me her PGB Employee ID No. 9833.

Doc. No. _____

Page No. _____
Book No. _____
Series of 2018.