Republic of the Philippines )

Province of Agusan del Norte )

Municipality of Buenavista ) S.S.

AFFIDAVIT OF ADMISSION OF PATERNITY

I, _________________________________________ of legal age, with residence and

post office address at _________________________________________, do hereby

solemnly swear that I am the father of child mentioned in the attached certificate of Live

Birth and named therein as _________________________________.

_________________________________
Signature

_________________________________
Name in Print

SUBSCRIBED AND SWORN to before me this __________ day of

__________________ by ______________________________ who exhibited to me his

Residence Certificate No. A _________________________ issued at

__________________________________ on ___________________________.

____________________________
Signature of Administering Officer

TERESITA K. VALDEHUEZA
Name in Print
Republic of the Philippines )
Province of Agusan del Norte )
Municipality of Buenavista ) S.S.

Registry No. ____________

AFFIDAVIT OF ACKNOWLEDGEMENT

I, _______________________________________ of legal age, Filipino and presently

Residing at ____________________________________________, after having duly sworn to

in accordance with law hereby, depose and state that :

1. I am the natural father of _______________________________________, who was

born in _____________________________________ on _________________;

2. Her mother is _____________________________________ whom I lived with as my

_____________________________ ;

3. I am executing this affidavit to attest to the truthfulness of the foregoing statement

and for purposes of acknowledging my child.

In truth whereof, I have hereunto affixed my signature this __________day of _________

2008 at _______________________________________.

SUBSCRIBED AND SWORN to before me this ____ day of _______________ 2008, at

Buenavista, Agusan del Norte.

TERESITA K. VALDEHUEZA
Municipal Civil Registrar
LILIA G. SUAMEN,