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RA 9048 Form No. 4.1 (LCRO)

RA 9048 Form No. 4.1 (LCRO)

(Devised 15 Aug. 2001)

Republic of the Philippines

City Civil Registry Office

City of Iloilo

Republic of the Philippines )

City of Iloilo) MIGRANT PETITION

SS RKCR-MANILA CITY

PETITION NO._____

PETITION FOR CHANGE OF FIRST NAME

I, PAULETTE L. GOLEZ, of legal age, Filipino and a resident of DURAN STREET ILOILO CITY PHILIPPINES, after having been duly sworn to in accordance with the law, hereby declare that:

(1) I am the petitioner seeking Change of First Name in My Certificatate of Live Birth

(2) I was born on November 21, 1970 at Sampaloc, Manila, Philippines.

(3) The birth was recorded under registry number 2219(k-70).

(4) The first name to be changed is from PAULITA to PAULETTE.

(5) The ground's for filling this petition are the following: I have habitually and continuously used PAULETTE and I publicly known in the community with that first name and my records show my first name as PAULETTE. I, therefore request that my first name in the birth certificate to be changed from PAULITA to PAULETTE.

(6) I submit the following documents to support this petition:

a) MY BIRTH CERTIFICATE (subject for change of first name)

b) MY BAPTISMAL AND MARRIAGE CERTIFICATE

c) MY OFFICIAL TRANSCRIPT OF RECORDS

d) MY SSS &amp VOTERS ID

e) MY NBI &amp POLICE CLERANCE

f) AFFIDAVIT OF NON EMPLOYMENT

g) AFFIDAVIT OF DISCREPANCY (7) I have not filed any similar petition and that, to the best of my knowledge, no other similar petition is pending with any LCRO, Court or Philippine Consulate.

(8)I am filing this petition at the LCRO of Iloilo City in accordance with R.A. No.9048 and its implementing rules and regulations.

(sgd) PAULETTE L. GOLEZ

Petitioner

VERIFICATION

I, Paulette L. Golez, the petitioner, hereby certify that the allegations are true and correct to the best of my knowledge and belief.

(sgd) PAULETTE L. GOLEZ

Petitioner

Subscribe and Sworn to before me this 6th day of May, 2010 in the City/Municipality of Iloilo City, petitioner exhibiting her Community Tax Certificate No. 13428199 issued at Iloilo City on January 26, 2010.

(sgd) ROMEO C. L. MANIKAN JR.

CITY CIVIL REGISTRAR

Administering Officer

Doc. No. ___

Page No. ___

Book No. ___

Series No.___

BANDERA: MAY 15 &amp 22, 2010

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