Republic of the Philippines

OFFICE OF THE LOCAL CIVIL REGISTRAR

City of Cebu

Republic of the Philippines )

City of Cebu ) S.S Petition No.______________

PETITION FOR CORRECTION OF CLERICAL ERROR

IN THE CERTIFICATION OF LIVE BIRTH

I, LOLITA FLORDELIS ZOZOBRADO, of legal age and a

resident of Lot 8, Block 2, San Jose, Ma. Village, Minglanilla, Cebu,
Philippines, after having been duly sworn in accordance with law,
hereby declare that:

1. I am the petitioner seeking correction of the clerical error

in my Certificate of Live Birth;

2. I was born on August 01, 1950 at Cebu City, Philippines;

3. The Birth was recorded under Registry Number 4155;

4. The clerical error to be corrected is:

Item No. Description From To

CHILD’S LAST NAME FLORDILES FLORDELIS

5. The said error was committed by mere inadvertence of the

person authorized to process the said document;

6. I submit the following documents to support this petition:

a. My Certificate of Live Birth

b. My Baptismal Certificate
c. Our Marriage Certificate
d. My COMELEC Voter’s ID
e. Birth Certificates of my Children
f. Senior Citizen ID

7. I use the last name FLORDELIS since my childhood and

that I believed in good faith that FLORDELIS is my true and real
surname such that I used it in all my government records, Marriage
Certificate, and Certificates of Birth of my children;
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 8. I am filing this petition to rectify my Certificate of Birth and
to conform with the abovementioned documents;

9. I have not filed any similar petition and that, to the best of
my knowledge, no other similar petition is pending with any Local
Civil Registrar Office, Court, or Philippine Consulate;

10. I am filing this petition at the Local Civil Registrar’s Office

of Cebu City, Philippines in accomplishing with Republic Act No. 9048
and its implementing rules and regulations;

11. I am executing this Affidavit to attest to the truth of the

foregoing statements and to correct the erroneous entry in my
Certificate of Live Birth.

IN WITNESS WHEREOF, I have hereunto affixed my signature

this 14th day of November 2019 at Cebu City, Philippines.

LOLITA FLORDELIS ZOZOBRADO

Affiant

SUBSCRIBED AND SWORN TO before me this 14th day of

November 2019 at Cebu City, Philippines, affiant exhibiting to me her
Senior Citizen’s ID with Control No. 102887 issued by Office for Senior
Citizens Affairs – Cebu City, as competent evidence of her identity.

Doc. No. 517 ;

Page No. 104 ;
Book No. I ;
Series of 2019 .

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