REPUBLIC OF THE PHILIPPINES)

DONE: CITY OF BAGUIO…………) S.S.

AFFIDAVIT OF DELAYED REGISTRATION

(RE: Affidavit to use the surname of father)

I, JULIE MANGILI MERO, of legal age, single, Filipino Citizen, and a

resident of #119-B Crescencia Village, Baguio City, Philippines, after having
been duly sworn to in accordance with law, hereby depose and state that:

1. I am the biological mother of SAVEHY ANZETA MERO who was born on

June 30, 2017 at Baguio General Hospital & Medical Center;

2. The biological father JOHN ANTHONY MARTIZANO MARASIGAN have

acknowledged the paternity as shown in the second page of the
Certificate Of Live Birth of SAVEHY ANZETA MERO which was registered
on July 11, 2017;

3. We used my surname which is “MERO”, so, I executed on May 28, 2018

an “AFFIDAVIT TO USE THE SURENAME OF THE FATHER” which is
“MARASIGAN” and I intended to file it with the City Local Registrar
(CLR);

4. On May 29, 2018, my partner JOHN ANTHONY M. MARASIGAN

suffered a stroke and died on the next day which is May 29, 2018, since
then I found no time to REGISTER OR SUBMIT the said “AFFIDAVIT TO
USE THE SURNAME OF THE FATHER”;

5. I am executing this affidavit to explain the Delayed Registration of the

“AFFIDAVIT TO USE THE SURENAME OF THE FATHER” and for all
legal intents and purposes it may serve.

IN WITNESS WHEREOF, we have hereunto affixed our signatures this

21 day of June, 2018 at Baguio City, Philippines.
st

JULIE MANGILI MERO

AFFIANT
SSS 01-1819785-0

SUBSCRIBED AND SWORN TO before me this 21st day of June, 2018, at

Baguio City, Philippines. Affiant personally appeared before me and the same
person who executed this instrument voluntarily.

MODESTO T. ANDONG
Notary Public
Commission No. 39-NC-18-R/Until: December 31, 2019
PTR No. 3397734/12-13-2017/Baguio City (for 2018)
IBP No. 1083758/12-13-2017/Baguio-Benguet Chapter (for 2018)
Roll No. 31289/5-15-81/Manila
Doc. No. 154; MCLE COMPLIANCE No. VI-0000192/June 14, 2016
Page No. 32; BIR TIN No. 121-017-652
Book No.XXX; No. 19, 2nd Floor Old Market Bldg.,
Series of 2018. Magsaysay Ave., Baguio City, Philippines