RA 9048 Form No. 1.

1 (LCRO)

Republic of the Philippines

Local Civil Registry Office
Municipality of Minglanilla
Province of Cebu

Republic of the Philippines ) Petition No.: ________________

______________________) SS

PETITION FOR CORRECTION OF CLERICAL ERROR IN THE

CERTIFICATE OF LIVE BIRTH

I, JESREIL NARCISO BAYER of legal age, Filipino, and a resident of Brgy.

Guiwanon, Barili, after having been sworn to in accordance with law, hereby declare that:
1) I am the petitioner seeking the correction of entry in:
a) my certificate of live birth
b) X The certificate of live birth of ________________________________ who is
my ____________________________________.

2) I/He/She was born on December 22, 2000 at Minolos, Barili, Province of Cebu.

3) The birth was recorded under registry number Local Civil Registry No. 2001-39.

4) The clerical error(s) to be corrected is/are (use additional sheets, if necessary)

ITEM NO. DESCRIPTION FROM TO
2 Sex Female Male
6 First Name of Ma. Elena Elena
Mother

5) The facts/reasons for filing this petition are the following: (use additional sheets if
necessary)
I filed this petition to make my records consistent with my documents such as
marriage certificate, records of birth and other documents.

6) I submit the following documents to support this petition: (use additional sheets if
necessary)
a) Certified True Machine Copies of my Certificate of Live Birth (Local Copies)
b) Certified True Machine Copies of my Certificate of Live Birth (PSA Copies)
c) Certificate of Baptism
d) Certificate of Marriage of my parents, RODOLFO R. BAYER and ELENA M.
NARCISO
e) Police Clearance
f) NBI Clearance
g) Voter’s Certification

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

8) I am filing this petition at the LCRO of Barili, Province of Cebu in accordance with RA
9048 and its implementing rules and regulations

1
 JESREIL NARCISO BAYER
Signature over Printed Name

VERIFICATION

I, JESREIL NARCISO BAYER, under oath, state:

1. I am the petitioner
2. I have caused the preparation of this petition
3. I have read the petition and all the facts stated here are true and correct to the best of my
personal knowledge and based on authentic records.

IN WITNESS WHEREOF, I have affixed my signature this

__________________________ at Barili, Cebu.

JESREIL NARCISO
BAYER
Signature over printed name

SUBSCRIBED AND SWORN to before me this _____________________________ at

Cebu City, Philippines petitioner exhibited to me his ID No. _____________________________
issued at _____________________ as competent evidence of identity.

________________________
Administering Office
Doc No.: ____;
Page No.: ____;
Book No.: ____;
Series of 2019.

For C/MCR use only

ACTION TAKEN BY THE C/MCR

Granted Denied (Provide basis for denial)

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

2
Date: ________ ________________________
City/Municipal Civil Registrar

For CRG use only

ACTION TAKEN BY THE CRG

Affirmed Impugned

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
_____________________________________________________________________________.

Date: ____________ _______________________

City Registrar General

OR No.: _________________________
Amount Paid: _____________________
Date Paid: ________________________