Republic of the Philippines)

Province of Tarlac..) S.S.

Municipality of Capas...)

AFFIDAVIT OF COHABITATION
FOR EXEMPTION FROM MARRIAGE LICENSE

We, HARLEY BENEDICT D. LAPIA and MINERVA C. DELA ROSA, both of

legal age, Filipinos, single, and both residents of Sto. Domingo, Capas, Tarlac, after being duly
sworn to in accordance with the law, hereby depose and state that:

1. We are considered common law husband and wife for about seven (7) years, having been
living together as such since the year 2010, but without the benefit of a lawful and valid
marriage;

2. That from the time we started to live together as husband wife and until the present, we both
possess all the legal qualifications and not suffering from any legal impediment to enter into
contract a lawful marriage;

3. That having continuously lived together as husband and wife from the said year until the
present, we are now ratifying our said cohabitation by contracting a marriage for the purpose
of its recording with the appropriate office of the government;

4. That accordingly, we have executed this affidavit for the purpose of contracting valid and
lawful marriage subject to exemption from obtaining a marriage license pursuant to the
provisions Article 34 of the Family Code of the Philippines;

5. That we attest to the veracity and truthfulness of the foregoing statement as we declare them
under oath in accordance with our own personal knowledge and belief.

IN WITNESS WHEREOF, we have hereunto set our hands this 30 th day of January 2017
at the Municipality of Capas, Province of Tarlac, Philippines.

__________________________ _________________________
Affiant Affiant

SUBSCRIBED AND SWORN TO before me this 30 th day of January 2017 at the

Municipality of Capas, Province of Tarlac, Philippines, the affiants having satisfactorily
established their identity to me by exhibiting to me ____________________________ and
____________________________ respectively, bearing their pictures and signatures, and that
they are the same person who appeared and signed the foregoing instrument in my presence and
within my jurisdiction, and who avowed to the truth of its content under the penalty of law.

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