REPUBLIC OF THE PHILIPPINES)

: S.S
VICTORIAS CITY )
X----------------------- x

AFFIDAVIT OF LATE OUT OF TOWN REGISTRATION

I, DEBBIE D. BUENDIA, of legal age, Filipino, with residence at Victorias City, Negros
Occidental, after first being duly sworn according to law, depose and say:

1. That I am the daughter of the applicant for the delayed registration of the birth
Certificate of Live Birth who is my mother, MARCELINA TOYHACAO DELUTE,
before the Office of the Civil Registrar of Victorias City, Negros Occidental;

2. That she was born on JANUARY 23, 1939, at Hinunangan, Southern Leyte through
her parents JULIAN DELUTE and DIONESIA A. TOYHACAO;

3. That due to inadvertence, her certificate of live birth was not reported and recorded in
the Office of the Civil Registrar of Hinunangan, Southern Leyte, and the Philippine
Statistics Authority, Manila;

4. That I am executing this affidavit to attest to the truth of the foregoing facts and
appraise the authorities concerned for the belated registration of her Certificate of
Live Birth;

5. That I am requesting the Civil Registrar of Victorias City, Negros Occidental to

process and endorse her certificate of Live Birth to the Office of the Civil Registrar
General pursuant to Rule 20 of A.O. No. 1, Series of 1993.

IN WITNESS WHEREOF, I have hereunto affixed my signature this ____ day of

_________________ 2020 at Victorias City, Negros Occidental.

DEBBIE D. BUENDIA
Affiant
__________________________

CORROBORATING STATEMENT

We, ____________________________and _____________________________, both of

legal age, married/single, Filipinos, and residents of Victorias City, Negros Occidental,
Philippines, do hereby depose and say that the foregoing statements are true and correct
according to our knowledge and belief.

__________________________ _____________________________
Affiant Affiant
_________________________ _____________________________

SUBSCRIBED AND SWORN to before me this ____ day of _______________ 2020 at

Victorias City, Negros Occidental, Philippines.

DOC. NO._____
PAGE NO. _____
BOOK NO. _____
SERIES 2020