Republic of the Philippines }

Capas, Tarlac } …………..S.S.

AFFIDAVIT OF FACTS OF BIRTH

I, LANIE SUPAN, of legal age, Filipino citizen, single and residing at

Barangay Balutu, Concepcion, Tarlac, after having been duly sworn to in
accordance with law, depose and state:
1. That I am the biological mother of PATRICK SUPAN also known as
JOHN PATRICK S PEREZ;
2. That on the April 29, 2000 at around 01:45PM in the afternoon in
237-Paso St. Bagumbayan, Taguig, Metro Manila, I gave birth to a
healthy baby boy whom later on named as “PATRICK SUPAN also
known as JOHN PATRICK S PEREZ”;
3. That PATRICIO C. PEREZ is the biological father of my son child who
is a legal age, Filipino, and residing at San Francisco, Concepcion,
Tarlac, that I am not legally married to PATRICIO C. PEREZ;
4. That PATRICIO C. PEREZ and I were together when I was still
pregnant to PATRICK SUPAN also known as JOHN PATRICK S PEREZ
and we only broke up prior to the birth of my son when he went home to
Taguig City;
5. That the time of birth of my son PATRICK SUPAN also known as
JOHN PATRICK S PEREZ I was with the impression that my son cannot
use the surname of his father Patricio C. Perez considering Patricio C.
Perez is legally married to another woman;
6. As such, I did not supply the name of Patricio C. Perez in the Birth
Certificate of my son during the preparation of the Birth Certificate,
Hence, in the birth certificate of my son PATRICK SUPAN also known as
JOHN PATRICK S PEREZ there was no father indicated in his birth
certificate of my son PATRICK SUPAN also known as JOHN PATRICK S
PEREZ;
7. That I’m executing this affidavit for whatever legal purpose it may
serve.
IN WITNESS WHEREOF, I have hereunto set my hand this 19 th day
of May 2023 in Capas, Tarlac, Philippines.

LANIE SUPAN
Affiant

SUBSCRIBED AND SWORN TO, before me this 19th day of May,

2023 at Capas, Tarlac, Philippines. The Affiant, Lanie Supan, personally
appeared and exhibited to me her Identification Card as competent proof
of her identity.

Doc. No. ______ ;

Page No. ______;
Book No. ______ ;
Series of 2023.