REPUBLIC OF THE PHILIPPINES)

CITY OF DAVAO )SS.

AFFIDAVIT TO USE SURNAME OF THE FATHER/

ACKNOWLEDGMENT

I, SASHA GREY, of legal age, Filipino, respectively and presently

residing at Blk. 55, Lot 6, Alpha Homes, Matina, Davao City, after having
been duly sworn to in accordance with law, depose and state that:
1. I am the biological mother of ROCCO SIFFREDU;
2. The biological father of the child is RAY GANADOS;
3. My child ROCCO SIFFREDU was born on November 18, 2019 in
Davao Doctors Hospital, Davao City;
4. The facts of birth of my child were duly registered at the Office of
the Davao City Registrar;
5. I, RAY GANADOS, being the father of ROCCO SIFFREDU,
hereby acknowledge and recognize him as my child and legal heir;
6. I am allowing my child ROCCO SIFFREDU to use my surname
GANADOS to be his surname in his Certificate of Live Birth;
7. I execute this affidavit to attest to the truth of the above facts in
compliance with the provisions of Republic Act No. 9255.

IN WITNESS WHEREOF, I have hereunto set my hand this 13th

day of December 2019 in the City of Davao, Philippines.

SASHA GREY
Affiant
Voter’s ID No. 89890
 SUBSCRIBED AND SWORN TO before me this 13th day of
December 2019 in Davao City, Philippines, affiant exhibiting to me her
valid proof of identification above-stated.

ATTY. FAITH IMEE D.

ROBLE
Notary Public for Davao City
Commission Serial No. 88888
Until Dec. 31, 2020
Attorney’s Roll No. 70888
PTR No. 12345– 02/18/19 – D.C.
IBP No. 54321– 02/18/19 – D.C.
Doc. No.____ Rm. 1E, Anda Corporate Center, Anda
St.,
Page No.____ Davao City, 8000, Philippines
Book No.____ Contact No.: (+63)945-445-6912
Series of E-mail
2019. Address: faithimeeroble@gmail.com