Republic of the Philippines

REGIONAL TRIAL COURT

Second Judicial Region
BRANCH 32
Cabarroguis, Quirino

PETITION FOR CORRECTION OF ENTRY IN THE CERTIFICATE OF LIVE BIRTH,

FROM 1994 TO 1998

GENIE ROSE L. TUGAC, SPL. PROC. CASE NO. 2019-02

Petitioner,

- versus –

THE LOCAL CIVIL REGISTRAR

OF DIFFUN, QUIRINO,
Respondent,

x-----------------------------------------------------x

JUDICIAL AFFIDAVIT OF
GENIE ROSE L. TUGAC

I, GENIE ROSE L. TUGAC of legal age, single, and resident of Don Faustino Pagaduan,

Diffun, Quirino petitioner in this case, state under oath as follows:

PRELIMINARY STATEMENT

The person examining me is Atty. Ma. Karen A. Baldonado-Guillermo with address at

Andres Bonifacio, Diffun, Quirino. The examination is being held at the same address. I am

answering her questions fully conscious that I do so under oath and may face criminal liability for

false testimony and perjury.

This affidavit/testimony of petitioner GENIE ROSE L. TUGAC is being offered to prove that

his date of birth were erroneously registered. The petitioner’s testimony is also offered Directing

the Local Civil Registrar of Diffun, Quirino to cause to be made the correction of his erroneous

birth date.

1. Q. Please state your name and other personal circumstances for the record.
A. I am GENIE ROSE L. TUGAC, ___ years old, of Don Faustino Pagaduan, Diffun, Quirino

2. Q. Are you the same GENIE ROSE L. TUGAC, the petitioner in this case?

A. Yes ma’am.

3. Q. Do you have any proof that your birth is being registered in Local Civil Registrars?
 A: Yes ma’am. The Authenticated Certificate of Live Birth, issued by the National Statistics
Office. ( Exhibit “A”)

4. Q: Are the information in your Certificate of Live birth correct?

A: No Ma’am.

5. Q: What particular information in your live birth is erroneously registered?

A: The date of my birth.

6: Q: What was the date of your birth being erroneously registered?

A: January 24, 1994, this should correctly be registered as January 24, 1998

7. Q: Do you have any proof that it should be January 24, 1998?

A: Yes ma’am. My TRANSCRIPT OF RECORD, CERTIFICATE OF DEDICATION

AND OTHER DOCUMENTS,( marked as Exhibits “B”,”B-1” and “C”)

8. Q: What are the effects of this erroneous information to you?

A: Such discrepancy greatly affects my personal data, and in order to avoid confusion and to
remedy the problem, I humbly ask the court to direct the Local Civil Registrar to cause to be made
the correction of the my erroneous birth date, as appearing in my Authenticated Certificate of Live
Birth (Annex “A”) from “January 24, 1994,” to “January 24, 1998”,

IN WITNESS WHEREOF, I have hereunto set my hand this __th day of ________ 2019 at
Diffun, Quirino, Philippines.

GENIE ROSE L. TUGAC

Affiant

SUBSCRIBED AND SWORN TO BEFORE ME on the date and at the place

indicated below. The affiant exhibited to me his competent evidence of identity as
indicated above.

Signed this 19th day of February 2019 at Diffun, Quirino.

Doc. No. _____;

Page No. ____;
Book No. ____;
Series.______;
 I, MA. KAREN A. BALDONADO-GUILLERMO, of legal age, Filipino, married with
postal Andres Bonifacio, Diffun, Quirino after being duly sworn depose and say:

1. I was the one who conducted the examination at my aforementioned office in Fe Marcos
Ave., (Four Lanes), Andres Bonifacio, Diffun, Quirino 3401;

2. I have faithfully recorded or caused to be recorded the questions I asked and the
corresponding answer that the witness gave;

3. I nor any other person then present or assisting her coached the witness regarding her
answers;

IN WITNESS WHEREOF, I have hereunto set my hand this ___th day of __________ 2019 at
Diffun, Quirino, Philippines.

ATTY. MA. KAREN A. BALDONADO-GUILLERMO

Affiant

SUBSCRIBED AND SWORN TO BEFORE ME on the date and at the place

indicated below. The affiant exhibited to me his competent evidence of identity as
indicated above.

Signed this ___th day of ___________ 2019 at Diffun, Quirino.

WITNESS MY HAND AND SEAL.

Doc. No. _____;

Page No. ____;
Book No. ____;
Series.______;