Republic of the Philippines

REGIONAL TRIAL COURT

Family Court
Branch ____
___ Judicial Region
__________City

IN RE: ADOPTION OF MINOR AND

CHANGE OF NAME OF
_________________ t0 ________________

________________,
- Petitioner,

- versus- SP. PROC. NO. ___________

LOCAL CIVIL REGISTRAR

OF _____CITY,
- Respondent.
x------------------------------------------x

PETITION
WITH ALL DUE RESPECT TO THE HONORABLE
COURT

Petitioner, through undersigned counsel, unto the Honorable

Court most respectfully alleges that:

1. The herein petitioner, ________________, is of legal

age, single, Filipino and with residence and postal
address at ________________ but for this
proceeding, her address shall be at (LAW OFFICE
ADDRESS), where she may be served with notices,
summons, orders and other court processes;

2. The respondent, the Local Civil Registrar of

________________ is herein impleaded as a nominal
party; the government office tasked to implement
whatever order/s that the Honorable Court may issue
relative to this case. Notices, orders, summons and other
court processes maybe served to said office at the
________________;

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3. Petitioner, ________________, is a single Filipino
citizen who is ___ years of age, having been born on
_____, copy of her Certificate of Birth is hereto attached
as Annex A. She had never been married and had never
begotten a child. While minor child,
________________, is _____ years of age, having
been born on ______ , copy of minors Certificate of
Live Birth is hereto attached as Annex B. From said
facts, the prospective ADOPTER is more than 16 years
older than the minor child proposed to be adopted;

4. The minor child is born to _______. Said biological

(parent) of the minor child has no stable means of
livelihood (REASON) with which to support her childs
basic, as well as essential needs. Her circumstances being
so, and for the best interest of the minor child, she had
left her child under the care of the petitioner and had
consented for her child to be adopted by the herein
petitioner. Copy of her Affidavit of Consent is hereto
attached as Annex C;

5. Such circumstance of the biological mother did not

however hinder her in making occasional visits at the
home of the petitioner to see how her child was doing;

6. Since the time ________________was brought to the

house of the petitioner, the latter had been the one acting
as mother to the child; giving her basic necessities, care,
comfort and love. She had provided her a home; a safe
and secure environment for her to grow up in;

7. ________________(biological parent)is
neither insane, nor intemperate. Neither did she
abandon her minor child, and she possess full knowledge
of petitioners intention to adopt her minor child and had
expressly given her consent to this adoption;

8. The petitioner is qualified under the law to adopt a child;

she being emotionally and psychologically capable of
caring for the minor child. She is financially and morally
capable of raising the child properly and adequately;

9. The petitioner is in possession of her full civil capacity

and legal rights, she is of good moral character and have

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 not been convicted of any crime involving moral
turpitude;

PRAYER
WHEREFORE, it is most respectfully prayed that after
due notice and hearing, judgment be rendered adjudging the
minor child, ________________, freed from all legal
obligations of obedience and maintenance with respect to her
natural parents and that she be declared to all legal intents and
purposes, the child of the herein petitioner, and that her name
follow that of the petitioner, thus ________________.

________________ City, Philippines, this

________________

DETAILS

VERIFICATION

AFFIDAVIT OF CONSENT

Page 3 of 6
REPUBLIC OF THE PHILIPPINES )
City of Baguio ) S.S.

VERIFICATION and CERTIFICATION

I, LIGAYA R. ABAD, of legal age, single, Filipino

citizen and with residence at Camp 7, Baguio City, Philippines
hereby declare under oath that:

1. I am the petitioner in the above-entitled case;

2. I have caused the preparation of this petition, the

contents of which are true and correct to the best of my
knowledge and belief;

3. I have not commenced any other action or proceeding

involving the same issues with the Supreme Court, Court of
Appeals, or any other tribunal or agency;

4. To the best of my knowledge, no such action or

proceeding is pending in the Supreme Court, Court of Appeals,
or any other tribunal or agency;

5. If I should thereafter learn that a similar action or

proceeding has been filed, or is pending before the Supreme
Court, Court of Appeals or any other tribunal or agency, I
hereby undertake to report that fact within FIVE (5) days there
from to the Honorable Court.

IN WITNESS WHEREOF, I have hereunto set my hand this

____ day of July 2006 at Baguio City, Philippines.

_____________________
LIGAYA R. ABAD

SUBSCRIBED AND SWORN TO before me this 19 th day of

July 2006 at Baguio City, Philippines, the person being
personally known to me to be the same person who executed
the foregoing document.

Doc. No. ___;

Page No. ___;
Book II;
Series of 2006

Page 4 of 6
REPUBLIC OF THE PHILIPPINES)
BAGUIO CITY ) S. S.

AFFIDAVIT OF CONSENT

I, MALOU SAN JOSE CUADERNO, of legal age, single,

Filipino citizen with residence and postal address at Quezon Hill,
Baguio City, after having been duly sworn to in accordance with law,
do hereby depose and state that:

1. I am the biological mother of one LEIZETTE JOY SAN

JOSE CUADERNO who was born on January 28, 2004 in
Baguio City;

2. I was not married when I gave birth to LIEZETTE JOY;

3. My friend, LIGAYA R. ABAD, had helped me greatly in

raising my minor child and had expressed her desire to adopt
my said child;

4. I am not insane, nor intemperate, nor have I abandoned said

minor child. I have full knowledge of the intention of LIGAYA
RAMOS ABAD to adopt my minor child and having the best
interest of my child in mind, I have consented to the adoption;

5. I am aware of the fact that once LEIZETTE JOY SAN JOSE

CUADERNO will be adopted, I shall lose ALL parental
authority and that she will become the legal child of LIGAYA
R. ABAD;

6. I am executing this AFFIDAVIT OF CONSENT freely and

voluntarily to attest to the truthfulness of my foregoing
statements and circumstances; to prove and show that I am
giving my consent to the adoption of my minor child
LEIZETTE JOY SAN JOSE CUADERNO by LIGAYA
RAMOS ABAD and for all other legal intents and purposes
it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 19th

day of July 2006 at Baguio City, Philippines.

MALOU SAN JOSE CUADERNO

Affiant

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 BIR TIN No. 456-873-221-000
Issued On: January 4, 2004
Issued At: Baguio City

SUBSCRIBED AND SWORN TO BEFORE ME this 19th day of

July 2006 at Baguio City. The Affiant exhibited to me her BIR TIN ID
Card with the number, date and place of issue as indicated below her
name and signature. She acknowledged to me that the same is her free
and voluntary act or deed.

WITNESS MY HAND AND SEAL.

Doc. No. ________;
Page No. ________;
Book No. ________;
Series of 0f 2006.

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