REPUBLIC OF THE PHILIPPINES )

CITY OF CABANATUAN ) S.S.

x------------------------x

AFFIDAVIT OF DISCREPANCY

I, FRUCTOSA BULACAN RIVERA, of legal age, Filipino Citizen, widow, and a

resident of Brgy. Poblacion Central, Gen. Tinio, Nueva Ecija, after having been sworn to in
accordance with law, do hereby depose and state, that:

1. My name is FRUCTOSA BULACAN RIVERA, who was born on August 23, 1950 in
General Tinio, Nueva Ecija;

2. In my OCT No. P-9878 issued by the Register of Deeds for the Province of Nueva Ecija
& in the Office of Provincial City Assessor my name entered therein is FRUCTUOSA
B. RIVERA. However, my real and correct name is FRUCTOSA B. RIVERA;

3. The names “FRUCTUOSA B. RIVERA” and “FRUCTOSA B. RIVERA” refers to one

and the same person;

4. This Affidavit has been executed to attest to the truth of all the foregoing facts and for
whatever legal intents and purposes this may serve.

IN WITNESS WHEREOF, we have hereunto set our hands this _____ day of
______________________, 20____, hereat Cabanatuan City, Nueva Ecija.

FRUCTOSA BULACAN RIVERA

Affiant

SUBSCRIBED AND SWORN to before me, this ___ day of ________________,

20___, hereat Cabanatuan City, Nueva Ecija. Affiant exhibiting to me her Competent Evidence
of Identity by way of OSCA ID No. 4355.

Doc. No.___________;
Page No.___________;
Book No.___________;
Series of 20_____.