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REPUBLIC OF THE PHILIPPINES REGIONAL TRIAL COURT FOURTH JUDICIAL REGION Branch ________ Dasmarias, Cavite

IN THE MATTER OF CANCELLATION/ CORRECTION OF ENTRIES IN THE CERTIFICATE OF LIVE BIRTH OF KIYUKO C. TERAUCHI PINKY ABRERA CANDELARIA Petitioner, ---versus--Special Proc. No. _________

CIVIL REGISTRAR OF DASMARIAS, CAVITE AND ALL PERSONS/ENTITIES WHO/WHICH MAY BE AFFECTED THEREBY, Respondents. x--------------------------------------x

PETITION
Petitioner, through the undersigned counsel and to this

Honorable Court, most respectfully states that:

1.

Petitioner is of legal age, Filipino, single, a resident of Blk.

1 Lot 27 Millwood Ville Pulo, Cabuyao, Laguna and the mother and guardian of her minor child KIYUKO CANDELARIA TERAUCHI; whereas Respondent - Civil Registrars are public officers in-charge of the registration and cancellation/correction of entries in the civil registrar where the fact of birth of the said minor child was registered, which registrar is located at Ground Floor, City Hall, City of Dasmarias;

2.

Petitioner conceived and gave birth to her child KIYUKO

CANDELARIA TERAUCHI on November 13, 1995 at De La Salle University Medical Center, Dasmarias, Cavite, out of wedlock with

Kazuya Terauchi, which fact of birth was registered on November 17, 1995 before the Office of Respondent Civil Registrar of Dasmarias, Cavite under Civil Registry No. 95-8418. Copy of the Certificate of Live Birth of Kiyuko C. Terauchi is hereto attached as Annex A;

3.

Prompted by the misbelief that her child, being born out of

wedlock, could not utilize the surname of her father Kazuya Terauchi, and that it is more convenient and easy to process the registration of her childs birth if she was married with Kazuya. Petitioner supplied erroneous information as regards the date and place of her marriage with Kazuya Terauchi;

5.

Petitioner

misrepresented

in

her

application

for

the

registration of birth of her child that she and Kazuya Terauchi were married on June 20, 1994 in Japan, when the truth of the matter is that they were and have not been married to this date. Copy of the Certification issued by the Civil Registrar General attesting to the fact that Petitioner has not been married to Kazuya Terauchi as their marriage does not appear in the National Indices of Marriage is hereto attached as Annex B; 6. As a result, Entry No. 18 referring to the date and

place of marriage of the parents of the said minor child, and consequently, Entry No. 20 particularly the printed name of herein Petitioner which was entered as PINKY TERAUCHI, instead of PINKY A. CANDELARIA, of Certificate of Live Birth of the child are false and misleading. Entry No. 18 in Annex A is hereto bracketed and marked as Annex A-1. While, Entry No. 20 in Annex A is further bracketed and marked as Annexes A-2;

7.

In order to correct the aforementioned misinformation and

erroneous entries in the Certificates of Live Birth of her minor child, Petitioner hereto files the instant Petition pursuant to Rule 108 of the Revised Rules of Court;

8.

Kazuya Terauchi, the father of the above-named child, who

has been permanently residing in Japan did not acknowledge nor admit paternity over the said child as he did not sign the Letter of Acknowledgment in the Certificate of Live Birth of Kiyuko.

PRAYER WHEREFORE, premises considered, it is most respectfully prayed to this Honorable Court that an Order be issued directing the herein Respondent Civil Registrars to cancel the information supplied as the date and place of marriage of parents in Entry No. 18 and to correct Entry No. 20, particularly the printed name of the herein Petitioner from PINKY TERAUCHI to PINKY CANDELARIA and to correct the surname of the minor child from KIYUKO CANDELARIA TERAUCHI to KIYUKO CANDELARIA in the Certificate of Live Birth of her minor child Kiyuko. Other reliefs just and equitable are likewise prayed for. Cabuyao City for Dasmarias City. April __________, 2013.

ATTY. NESTOR A. LOABLE Counsel for the Petitioner 216 Banlic, Cabuyao City, Laguna, Philippines PTR No. 0036913/Jan. 3, 2013/Cabuyao City IBP NO. 907365/Jan. 3, 2013/Laguna Chapter Attorneys Roll No. 59142/MCLE Compliance IV-0010420 REPUBLIC OF THE PHILIPPINES) CITY OF CABUYAO )SS VERIFICATION AND CERTIFICATION AGAINST FORUM-SHOPPING I, PINKY CANDELARIA-NAKAYAMA, married, of legal age, Filipino and a resident of Blk. 1 Lot 28 Millwood Ville, Pulo, Cabuyao, Laguna, after having been duly sworn to in accordance with law, do hereby depose and state that:

1. I am the Petitioner in the foregoing Petition and I have caused the preparation of the same, the contents of which are all true and correct to the best of my personal knowledge, information and belief; 2. I certify that neither have I commenced nor is there any pending Petition of similar nature before any court, tribunal or quasijudicial agency, and if I should hereafter learn that the same or similar Petition has been filed or is pending in any court, tribunal or quasijudicial agency, I shall report the fact within five (5) days therefrom to this Honorable Court. IN WITNESS WHEREOF, I have hereunto set my hand this ____________ day of April, 2013 in Cabuyao City. PINKY CANDELARIA-NAKAYAMA Affiant

SUBSCRIBED AND SWORN to before this ______ day of ________________, 20___ at _____________________________.

NOTARY PUBLIC Doc. No. _____; Page No. _____; Book No. _____; Series of _____;