REPUBLIC OF THE PHILIPPINES )

CAMILING, TARLAC ) S.S

AFFIDAVIT
I, DAWN ANGELA MONIQUE GOLINGAN, of legal age, Filipino citizen, married,
and a resident of Barangay Paterno St., Poblacion D, Camiling, Tarlac, Philippines, after
having been duly sworn to in accordance with law, do hereby depose and state THAT:

1. I am the mother of KYLE CEAZAR CHIM GOLINGAN (Kyle Ceazar, for

brevity), who was born on November 16, 1999;

2. Kyle Ceazar despite being a minor begot a child named TRACEY NICOLE
VICTORIO GOLINGAN born on May 26, 2017 at the Gilbert Teodoro
Memorial Hospital, Camiling, Tarlac with Jamel Erica Victorio;

3. Kyle Ceazar voluntarily acknowledges that Tracey Nicole is his own daughter
and he desires to have her birth be registered before the Local Civil Registry
of Camiling, Tarlac;

4. However, since Kyle Ceazar is still a minor, he could not possibly do so

without my parental assistance and concurrence to such intended act;

5. I am executing this affidavit as a manifestation that I gave my parental

guidance and approval to my minor son Kyle Ceazar to acknowledge his
daughter and have such birth be properly recorded before the Local Civil
registry of Camiling, Tarlac;

6. Finally, I am executing this Affidavit to attest to the truth of the foregoing

statements and for whatever legal intents and purposes this may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 6 th day of

June, 2017 at Camiling, Tarlac, Philippines.

DAWN ANGELA MONIQUE GOLINGAN

Affiant

SUBSCRIBED AND SWORN to before me on the date and place indicated

above. Affiant exhibited before me her employment ID Card with Employee No. MSWD-
39 issued by the LGU-Camiling, Tarlac.

Doc. No.:______;
Page No.:______;
Book No.:______;
Series of 2017.