REPUBLIC OF THE PHILIPPINES )

PROVINCE OF TARLAC ) S.S.

SWORN STATEMENT

I, HERMINIGILDA MAGLALANG DELA CRUZ, of legal age, Filipino, widow and a

resident of 730-A Don Juico, Riverside Subd., Brgy. Anunas, Angeles City, Pampanga , after
having been duly sworn to in accordance with law hereby depose and say:

1. That I am the widow of the late FELICIANO SANTOS DELA CRUZ ;

2. That we were married on May 8, 1946 in Concepcion, Tarlac before Rev. Fr.
Jose S. Sunga;

3. That however, upon inquiry at the Philippine Statistics Authority (PSA) and at
the Office of the Local Civil Registrar of Concepcion, Tarlac , it was discovered
that my husband and I do not have any record of our marriage;

4. That I hereby attest that Feliciano dela Cruz and I were married on May 8, 1946
in Concepcion, Tarlac as evidenced by the photocopy of my Marriage Contract;

5. That I am securing the registration of the Marriage Contract at the Office of the
Civil Registrar of Concepcion, Tarlac;

6. That I hereby certify that the statements made herein are true and correct to the
best of my knowledge and belief and for the purpose of registering my marriage
with Feliciano Dela Cruz.

IN WITNESS WHEREOF, I have hereunto set my hand this 10 th day of July, 2018 at
Tarlac City, Tarlac.

HERMINIGILDA M. DELA CRUZ

Affiant

SUBSCRIBED AND SWORN to before me on the date and place abovewritten affiant
exhibiting to me her Senior Citizen ID No. CH-8327 issued on 6-4-13 at Angeles City.

JOSELITO C. CASTRO
Doc. No. ___; Notary Public
Page No. ____; Until December 31, 2019
Book No. II ; IBP Lifetime No. 07355/1-07-08/Tarlac City
Series of 2018. PTR No. 3367766/1-03-18/Tarlac City
Roll of Attorneys No. 49046