AFFIDAVIT OF CHANGE STATUS

I, JENALYN TOLENADA PUERTO, of legal age, Filipino, married to BRYAN

ACOSTA GARCIA and residents of Brgy. Danzo, Gerona, Tarlac, in accordance with law,
under oath hereby state;

That I am employed as a TEACHER II in the DepEd Tarlac Province- Birbira High

School, Birbira, Camiling Tarlac;

That I am requesting the Civil Service Commission Regional Office No. 3

San Fernando Pampanga to change my name as appearing in the records of the
Civil Service Commission (CSC) from MS. JENALYN TOLENADA PUERTO to
MRS. JENALYN PUERTO GARCIA by reason of my marriage to BRYAN ACOSTA
GARCIA;

That hereto attached is the duly certified/ authenticated true copy of my

Marriage Contract/ Certificate of Marriage BRYAN ACOSTA GARCIA solemnized before by
REV. FR. OSIAS Jr. C. IBARRA on June 19, 2021 at the Magaspac, Gerona, Tarlac,
Philippines.

That the above-mentioned attached Marriage Contract/Certificate of Marriage is genuine

and not spurious/ fake and was validly issued by the proper authority;

That the foregoing statements are not given as gross misrepresentations designed to
unlawfully persuade the CSC to change its existing records;

That the foregoing statements/ documents are given/ submitted under pain of
PERJURY/ FALSIFICATION OF OFFICIAL DOCUMENTS against the affiant if warranted.

IN TESTIMONY WHEREOF, I have hereunto affixed my signature this 8 th day of

August at Tarlac City, Tarlac, Philippines.

JENALYN T. PUERTO
Affiant

SUBSCRIBED AND SWORN to before me this ________ day of _____________ at

Tarlac City, Tarlac, Philippines.

Doc. No. Notary Public

Page No.

Book No.

Series of
 Republic of the Philippines
DEPARTMENT OF EDUCATION
Region III-Central Luzon
Schools Division of Tarlac Province
BIRBIRA HIGH SCHOOL
Camiling, Tarlac

August 8, 2021

RONALDO A. POZON, PhD, CESO V

Schools Division Superintendent- Tarlac Province
Macabulos Drive, San Roque, Tarlac City

Dear Sir,

May I request your good office to please update the current name of JENALYN T. PUERTO to
JENALYN P. GARCIA.

Enclosed is a copy of her marriage certificate to support her change of name.

Hoping for your preferential action and consideration.

Thank you very much.

Very truly yours,

MS. JENALYN T. PUERTO

Teacher II
0907-975-3848

Approved:

RONALDO A. POZON, PhD, CESO V

Schools Division Superintendent- Tarlac Province