Joint Affidavit

Republic of the Philippines )

City of Dipolog ) S.S.

We, Leticia Racelis and Leo Racelis, both Filipinos, of legal ages and residents of
Taga, Daanglungsod, Katipunan, Zamboanga del Norte, respectively, having been duly sworn in
accordance with law, hereby depose and state:
(a) That we know the person of Eduardo Balancar because he was a resident of the
aforementioned Barangay of which we resides;
(b) That we know for a fact that said Eduardo Balancar died on August 30, 2023 at Z Mall,
Barangay Poblacion, Dipolog City due to heart attack; and
(c) That we are executing this affidavit to attest to the truthfulness of the fact of death of the
person of Eduardo Balancar and for whatever legal purposes that this statement may
serve.

IN WITNESS WHEREOF, we have hereunto set our hands this 30 th day of August 2023,
in the City of Dipolog, Province of Zamboanga del Norte, Philippines.

Affiant:

LETICIA RACELIS ____________________

Signature

Affiant:

LEO RACELIS _____________________

Signature

LEOREBELLE B. RACELIS
Notary Public for Dipolog City

Until December 31, 2030

Municipal Hall, Barangay Dos, Katipunan, Zamboanga
del Norte
PTR No. 123/ Makati City/ 12-31-13
Roll of Atty. No. 123456
IBP No. 001122/ Dipolog City/ May 21, 2030
Doc No. 2
Page No. 2
Book No. 1
Series of 2023
 Affidavit of Birth

REPUBLIC OF THE PHILIPPINES )

MUNICIPALITY OF KATIPUNAN ) S.S.

I, Analou Bacatan, Filipino, of legal age, single, and resident of Barangay Uno,
Katipunan, Zamboanga del Norte, Philippines, having duly sworn in accordance with law, hereby
depose and state:

(a) That I am a duly-licensed midwife with Professional License No. 123456 issued
on January 27, 2009 at Makati City, Manila;
(b) That on or about 12:00 midnight of May 15, 1993, I personally attended to a
patient named Leticia Racelis in giving birth by normal delivery to a baby girl
whom they named as Leorebelle; and
(c) That I execute this Affidavit to the truth of the foregoing facts and fo any other
legal purposes that this Affidavit may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 30 th day of August 2023 at
the Municipality of Katipunan, Province of Zamboanga del Norte, Philippines.

ANALOU BACATAN
Affiant

_____________________

Signature

LEOREBELLE B. RACELIS
Notary Public for Municipality of Katipunan

Until December 31, 2028

Municipal Hall, Barangay Dos, Katipunan, Zamboanga
del Norte
Commission No. 051593
Bulwagan, Quezon, Dipolog City
Roll of Attorney No. 68
PTR No. 890 (Quezon City, Manila/May 02, 2029
IBP No. 34589 (Quezon City, Manila/May 02, 2029

Doc No. 2
Page No. 2
Book No. 1
Series of 2023
 Affidavit of Illegitimacy of a Child

Republic of the Philippines )

City of Dipolog ) S.S.

I, Leorebelle B. Racelis, Filipino, of legal, age, single, and a resident of Taga,

Daanglungsod, Katipunan, Zamboanga del Norte, Philippines, having duly sworn in accordance with
law, hereby depose and state:
(a) That I am the mother of Belle Evans who was born on May 15, 2000 at the
Zamboanga del Norte Medical Center, Dipolog City, Zamboanga del Norte,
Philippines.
(b) That as appearing in the records of Office of the Civil Registrar of the City of
Dipolog, Philippines, the father of the said child is Chris Evans, who is an
American citizen. The same is certified by the attached of Live Birth of the said
child;
(c) That I hereby affirm and attest to the truth of the fact that the father of the above
mentioned child is indeed Chris Evans;
(d) That I also declare that under the laws of the Philippines or the United States of
America, I and Chris Evans were not incapacitated to marry each other at the
same time of the conception or birth of the said child, nor are we incapacitated
to marry each other now or in the future; and
(e) That I am executing this affidavit to attest to the truth of the foregoing facts.

IN WITNESS WHEREOF, I have hereunto set my hand this 30 th day of August

2023 at the City of Dipolog , Province of Zamboanga del Norte, Philippines.

LEOREBELLE B. RACELIS
Affiant

________________________
Signature

LEOREBELLE B. RACELIS
Notary Public for Dipolog City

Until December 31, 2030

Municipal Hall, Barangay Dos, Katipunan, Zamboanga
del Norte
PTR No. 123/ Makati City/ 12-31-13
Roll of Atty. No. 123456
IBP No. 001122/ Dipolog City/ May 21, 2030
Doc No. 2
Page No. 2
Book No. 1
Series of 2023