Republic of the Philippines

City of Puerto Princesa City

)
)S.S.

AFFIDAVIT OF DELAYED REGISTRATION OF DEATH

That I, MERCY G. DELA CUESTA, of legal age, widow, Filipino and a
resident of 214 Manalo St., Brgy. Milagrosa, Puerto Princesa City, Philippines,
after having been duly sworn to in accordance with law, hereby depose and say:
1. That I am the daughter of the deceased ALEJANDRO ENRIQUEZ
GUEVARRA who was a resident of Brgy. Iwahig, Puerto Princesa City,
Palawan;
2. That said ALEJANDRO ENRIQUEZ GUEVARRA died on March 21, 2000
at Brgy. Iwahig, Puerto Princesa City, Palawan but his death was not
registered at the Local Civil Registrar of Puerto Princesa and thus has no
Certificate of Death;
3. The reason for such was the fact that when he died, the person who was
tasked with registering his death inadvertently forgot to register the same
with the proper Office of the Civil Registrar;
4. That I am now responsible and cause the delayed registration of death of
said ALENJANDRO ENRIQUEZ GUEVARRA with Office of the Civil
Registrar of Puerto Princesa City;
5. That I am executing this Affidavit to attest to the truth of the foregoing
facts and to use the same for whatever legal purpose it may serve her
best.
IN WITNESS WHEREOF, I have hereunto set my signature this 10 th day of
September 2015 at Puerto Princesa City, Philippines.

MERCY G. DELA CUESTA

Affiant
DL ID No. D11-15-003240
SUBSCRIBED AND SWORN to before me this 10th day of September, 2015 at Puerto
Princesa City, Philippines, affiant exhibited to me her proof of identity as shown below her
name and signature.
NOTARY PUBLIC

Doc. No._______;
Page No._______;
Book No. ______;
Series of 2015.