Affidavit of Delayed Registration Death

Download as doc, pdf, or txt
Download as doc, pdf, or txt
You are on page 1of 1

Republic of the Philippines )

City of Cebu ) S.s.

AFFIDAVIT OF DELAYED REGISTRATION OF DEATH

I, ANN TRINITAS GONZALES-VIDAL, Filipino, of legal age, married and


residing at 42-1 Pelaez Extension, Brgy. Sta. Cruz, Cebu City, after having been
duly sworn to in accordance with law, hereby depose and state, THAT:

1. I am the applicant for the delayed registration of the death of my father


Romanito Alba Gonzales, who died on November 29, 2017 at the Perpetual
Succour Hospital, Gorordo Avenue, Cebu City;

2. The reason for the delay in the registration of the same is because of we
were not able to immediately complete the paperwork for the same due to
funeral preparations;

3. I am executing this affidavit to attest to the veracity and truth of the


foregoing;

IN WITNESS WHEREOF, I have hereunto affixed my signature this ___


day of January 2018 in the City of Cebu, Philippines.

ANN TRINITAS GONZALES-VIDAL


Affiant

SUBSCRIBED AND SWORN TO BEFORE ME THIS ___ day of


January 2018 in the City of Cebu, Philippines, the affiant presented to me her
Philippine Passport No. EB9952637 which is valid until January 8, 2019 as her
proof of identity.

A LV I N B U T C H E . C A Ñ A R E S
Doc No. ____ Notary Public for the City of Cebu
Page No. ___ Until December 31, 2018 per Commission No. 11-07
Book No. X 3rd Floor, 45 West Capitol Bldg.
Series 2018 Corner N. Escario & Don Gil Garcia Sts.,
Brgy. Capitol Site, Cebu City
Atty. Roll No. 38629/MCLE V No.0010700; 09/25/15
IBP No. AR001157-1/09/18 - Cebu City
PTR No. 8893571-1/09/18 - Cebu

You might also like