REPUBLIC OF THE PHILIPPINES )

Lucena City ) S.C.

AFFIDAVIT

I, MARIA DOLORES VILLADIEGO NADERA, of legal

age, Filipino and a resident of Brgy. Masin, Tayabas City,
after having been duly sworn to according to law, hereby
depose and state the following:

That I am the biological mother of ZHANELLE MARVEY

LAINE VILLADIEGO NADERA who was born on May 4, 2006
at Lucena City;
That in the Certificate of Live Birth of my said daughter
issued by the Mt. Carmel General Hospital, Lucena City, her
name appears as ZHANELLE MARVEY LAINE VILLADIEGO
NADERA and her father is indicated as Christian Harvey
Abadilla Nadera (now deceased) who died on March 24,
2019 in Tayabas City;
That when she was born, we were not yet married and
there is no impediment for us to marry except my age and
we got married on May 11, 2016 in Tayabas City;
That the name of my said child should be registered in
her Certificate of Live Birth, as ZHANELLE MARVEY LAINE
VILLADIEGO NADERA. In fact, her father acknowledged
her as his daughter in his father’s PhilHealth record, in her
Progress Report Card issued by Kiddie School Early
Childhood Leaning Center, Tayabas City and in her
Baptismal Certificate issued by Roman Catholic Diocese of
Lucena;
That I attest to the truth of the foregoing and I am
executing this affidavit for whatever legal purpose/s it may
serve.
IN TRUTH WHEREOF, I have hereunto signed my
name below, this 8th day of July, 2019 at Lucena City.
.

MARIA DOLORES VILLADIEGO NADERA

Affiant
PhilHealth ID No. 02-050819172-4
SUBSCRIBED AND SWORN to before me this 8th day of July,
2019 at Lucena City.
 LIRIO R. MUÑOZ
Public Attorney II
Pursuant to RA 9406
Doc. No.:___;
Page No.:___;
Book No.:___;
Series of 2019.

AFFIDAVIT OF ACKNOWLEDGMENT AND CONSENT TO CHANGE THE

SURNAME OF THE MINOR PRINCE JAROLD ATIENZA
 I, ANA JOELLA PALIVINO ATIENZA, of legal age, single, Filipino
and a resident of Brgy. I, Lucena City, after having been duly sworn
to according to law, hereby depose and state the following:

1. That I am the biological mother of PRINCE JAROLD ATIENZA

who was born on NOVEMBER 15, 2013 at Quezon Medical
Center, Lucena City

2. That the biological father of the said child is HERMAN ARASAS

EDAD who refused to recognize and acknowledge PRINCE
JAROLD ATIENZA as his child;

3. That the name of the father on the Certificate of the Father

should be indicated as UNKNOWN instead of HERMAN ARASAS
EDAD;

4. That the name of my said child should be registered in his

Certificate of Live Birth as PRINCE JAROLD ATIENZA and not as
PRINCE JAROLD EDAD;

5. That I am executing this affidavit for whatever legal purpose/s

it may serve.

IN TRUTH WHEREOF, I have hereunto signed my name below,

this 10th day of January, 2019 at Lucena City.
.

ANA JOELLA PALIVINO ATIENZA

Affiant
Yellow Card ID No. 88-B01-02292
SUBSCRIBED AND SWORN to before me this 10th day of
January, 2019 at Lucena City.

MARIA JOCELYN D. BASCUGUIN

Public Attorney II
Pursuant to RA 9406
Doc. No.:___;
Page No.:___;
Book No.:___;
Series of 2019.