RA 9048/ R.A. 10172 Form No. 1.1.

(LCRO)
(Modified 7 January 2013)

REPUBLIC OF THE PHILIPPINES

LOCAL CIVIL REGISTRY OFFICE
Province of Davao del Norte
CITY OF PANABO

Republic of the Philippines )

Province of Davao del Norte
City of Panabo....................) S.S Petition No. ______________

PETITION FOR CORRECTION OF CLERICAL ERROR

IN THE CERTIFICATE OF LIVE BIRTH

I, MARIA CATALINA GUTIERREZ MAZO, of legal age, Filipino, married, and a resident of
Panabo City, Davao del Norte, Philippines after having been duly sworn to in accordance with law,
hereby declare that:
1. I am a petitioner seeking correction of the clerical error in:

a) My Certificate of Live Birth;

2. I was born on April 5, 1960 at Davao City, Philippines;

3. My birth was recorded under registry number 8524;

4. The clerical error to be corrected is: (Use additional sheets, if necessary.)
Item No. Description From To
1 Child’s Middle Name Osido Ocido
6 Date of Birth April 4, 1960 April 5, 1960
12 Mother’s Last Name Osido Ocido

5. The facts/reasons for filling this petition are the following: (Use additional sheets, if necessary.)
TO CORRECT THE CLERICAL ERROR ENTERED IN MY BIRTH CERTIFICATE. IT WAS
REFLECTED THAT MY MAIDEN MIDDLE NAME IS OSIDO, WHEN IN TRUTH AND IN FACT
IT IS OCIDO. MY BIRTHDATE WAS LIKEWISE REFLECTED APRIL 4, 1960, WHEN IN
TRUTH AND IN FACT IT IS APRIL 5, 1960.
6. I submit the following documents to support this petition: (Use additional sheets, if necessary.)
a) CERTIFICATE OF BAPTISM;
b) CERTIFICATION FROM DEPED REGION XI;
c) CERTIFICATE OF EMPLOYMENT FROM CHRMO-PANABO;
d) NBI CLEARANCE; AND
e) PHILIPPINE NATIONAL POLICE CLEARANCE.

7. I have not filed and similar petition and that, to the best of my knowledge, no longer similar
petition is pending with any LCRO, Court or Philippine Consulate.
8. I am filing this petition at the LCRO of PANABO CITY, DAVAO DEL NORTE, PHILIPPINES.
(city/municipality) (province)

in accordance with RA No. 9048 and its implementing rules and regulations.

MARIA CATALINA G. MAZO

Signature over printed name of petitioner
 VERIFICATION
I, MARIA CATALINA G. MAZO, the petitioner, hereby certify that the allegations herein are true
and correct to the best of my knowledge and belief.

MARIA CATALINA G. MAZO

Signature over printed name of petitioner

SUBSCRIBED AND SWORN to before me this 13th day of March, 2024, in the City of Panabo,
petitioner exhibiting his/her Competent Evidence of Identity PH NATL ID NO. 5028-5742-0729-
0846.

Doc. No. ________________

Page. No. ________________
Book No. I ;
Series of 2024.

For C/MCR use only

ACTION TAKEN BY THE C/MCR

Granted Denied (Provide the basis for denial.)

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Date: _____________________ _____________________________

City / Municipal Civil Registrar

For CRG use only

ACTION TAKEN BY THE CRG
Affirmed Impugned

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Date: ____________________________ ___________________________

Civil Registrar General

Payment of filing fee (Please attach copy of the official receipt.)

O.R. No. ________________
Amount Paid ________________
Date paid ________________