REPUBLIC OF THE PHILIPPINES )

IBA, ZAMBALES )SS.

AFFIDAVIT OF CIVIL STATUS

I, FLORITA M. KELLER, of legal age, Filipino, and resident of Sabang, Sta

Cruz, Zambales, after having been duly sworn to in accordance with law, hereby
voluntarily depose and say THAT:

1. I was born on September 19, 1963 at Sta Cruz, Zambales;

2. My civil status at present is - MARRIED;
3. I married GREGORY ALLEN KELLER an American citizen on November 22,
1985 at Honolulu, Hawaii, USA (Attached herewith is the copy of our Marriage
Certificate as Annex “A”);
4. I execute this affidavit to attest to the truth of the foregoing facts and for any legal
purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this ____ day of

October, 2021 at Iba, Zambales.

FLORITA M. KELLER
Affiant

SUBSCRIBED AND SWORN to before me, this ____ day of October, 2021 at
Iba, Zambales.

Doc No._______
Page No._______
Book No._______
Series of 2021.