REPUBLIC OF THE PHILIPPINES

LOCAL CIVIL REGISTRY OFFICE

CITY OF MUNTINLUPA

Republic of the Philippines )

City of Muntinlupa ) Petition No. ______________
______________________) SS

PETITION FOR CHANGE OF LAST NAME

I, Celyn Buenaventura, of legal age, Filipino, and a resident of

No. 66 Makatotohanan Street, Sinungaling Subdivision
Muntinlupa City after having been duly sworn to in accordance
with law, hereby declare that:

1. I am a petitioner seeking correction of the clerical error in:

a) my Certificate of Live Birth

b) the Certificate of Live Birth of Teresa Apolinario who is my

Mother

2. I was born on 10 March 1985 at Muntinlupa General Hospital

3. The birth was recorded under registry number 262829-8.

4. The last name to be changed is from Buenaventura to

Marasigan.

5. The grounds for filing this petition are the following: My real
biological parents are surnamed Marasigan.
6. I submit the following documents to support this petition:
(Use additional sheets, if necessary.)

a) NSO Original birth certificate

b) Certificate of live birth

7. I have not filed and similar petition and that, to the best of my
knowledge, no longer similar petition is pending with any
LCRO, Court or Philippine Consulate.

8. I am filing this petition at the LCRO of Muntinlupa.

in accordance with RA No. 9048 and its implementing rules and

regulations.

__________________________________
Signature over printed name of
petitioner
 VERIFICATION

I, Celyn Buenaventura, the petitioner, hereby certify that the

allegations herein are true and correct to the best of my
knowledge and belief.

________________________
Signature over printed name of petitioner

SUBSCRIBED AND SWORN to before me this 28th day of

January 2013 in the city of Muntinlupa, petitioner exhibiting his
Community Tax Certificate No. 52741 issued at Muntinlupa on
Movember.

Doc. No. 2163

Page. No. 28
Book No. 31 Administering Officer
Series of 2013
For C/MCR use only