Republic of the Philippines )

Province of Albay ) S. S.
Municipality of Sto. Domingo )

AFFIDAVIT

I, NILA BARCELON BANZUELA, Filipino citizen, widow and now a resident of Purok 2, Barangay
Salvacion, Sto. Domingo, Albay, after having been duly sworn to in accordance with law, hereby depose and
say:

1. That I am the surviving spouse of JOSE BASE BANZUELA, also a Filipino, who died last
February 9, 2022 of Cardiogenic Shock secondary to STLMI at Albay Doctor’s Hospital, Legazpi
City;

2. That we got married on June 15, 1971 at the Office of the Mayor, Sto. Domingo, Albay
solemnized by then Municipal Mayor of Sto. Domingo, Albay, Aida Surtida Abrigo;

3. That we were both single when we got married and were then aged 21 and 20 years old,
respectively, during that time and with the blessing of his parents, Catalino Banzuela and Teodora
Base and of my parents, Preciliano Barcelon and Victoria Apinado;

4. That our marriage was solemnized in the presence of our instrumental witnesses , his relatives,
Juan Banzuela and Juanita Banzuela, however, they are now both deceased;

5. That my husband and I was confident that our marriage was registered with the Office of the
Municipal Civil Registrar of Sto. Domingo, Albay, but just recently, I found out that it was not
registered with the said office and even at PSA;

6. That despite effort to look for my personal copy of said document, but to no avail;

7. That I am executing this affidavit to attest the truth of the above stated facts in support to my
application for late registration of our marriage the CCR of WITH THE Office of the Ckvl
Registrar.

IN WITNESS WHEREOF, I have hereunto set my signature this _______ day of May 2022 at Sto.
Domingo, Albay.

NILA BARCELON BANZUELA

Affiant
Senior Citizen ID No. 22-3398
Issued on 3/1/2022
At Sto. Domingo, Albay

SUBSCRIBED AND SWORN to before me this ________ day of May 2022 at Sto. Domingo, Albay.

__________________________________
Administering Officer