Republic of the Philippines )

Municipality of ______ )S.S.

x- - - - - - - - - - - - - - - - - - - -x

AFFIDAVIT OF DISCREPANCY
I, MARGIELYN BUENAVISTAJAVIER, of legal age, Filipino and a resident
of Brgy. ________, _________, La Union, after first being duly sworn to on oath in
accordance with law, hereby depose and state that:

I am the biological mother of John Miguel Buenavista Marquez, a minor, who was
born on December 5, 2015 at ______________, _____, La Union.

That in the Certificate of Live Birth of my son, John Miguel Buenavista Marquez,
my residence therein was reflected as Brgy. Garcia, Agoo, La Union instead of Brgy.
Acacia, Agoo, La Union, which is my actual and real residence;

That likewise, the residence of Johnny Madriaga Marquez, my common-law

husband and the father of John Mark Buenavista Marquez, was indicated as Brgy Garcia,
Agoo, La Union, instead of Brgy. Acacia, Agoo, La Union, which is the actual and real
residence of Johnny Madriaga Marquez.

That I am executing this to attest to the truthfulness of the above-narrated facts,

and for all legal intents and purpose

IN WITNESS WHEREOF, I hereby affix my signature this 24 th day of June 2022

at Tubao, La Union.

MARGIE BUENAVISTA JAVIER

Affiant
ID No. _________
(with picture)

SUBSCRIBED AND SWORN TO before me this ___ day of June 20__ at

_______, La Union, affiant having personally appeared before me and exhibiting to me
her Identification Card, with picture, which I consider as competent evidence of her
identity.

Doc. No. ____;

Book No. ____;
Page No. _____;
Series of 2022.