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RA 9048 Form No. 1.1. (LCRO)

(Devised 21 January. 2016)

Republic of the Philippines

Local Civil Registry Office
Province: CAGAYAN
City/Municipality: TUGUEGARAO

Republic of the Philippines )

) SS Petition No. 1 2 2 1 2 1

PETITION FOR CORRECTION OF CLERICAL ERROR

IN THE CERTIFICATE OF LIVE BIRTH

I, DENIELLE U. BOSITO of legal age, FILIPINO ,

(Complete name of petitioner) (Nationality/Citizenship)
and a resident of ZONE 2, LAKAMBINI, TUAO EAST, CAGAYAN ,
(Complete address)
after been having duly sworn to in accordance with law, hereby declare that:

1) I am the petitioner seeking the change of first name in:

a) X my Certificate of Live Birth
b) The Certificate of Live Birth of
(Complete name of owner)

who is my .
(Relation of owner to the petitioner)

2) I/He/She was born on DECEMBER 21, 1999 at TUGUEGARAO ,

(Date of Birth) (City/Municipality)
CAGAYAN , PHILIPPINES .
(Province) (Country)
3) The birth was recorded under registry number 24680 .
4) The clerical error(s) to be corrected is (are): (Use additional sheets, if necessary.)
Item No. Description From To
3 First name of the child DANIELLA DENIELLE

5) The facts/reasons for filling this petition are the following: (Use additional sheets, if necessary.)
That my true and real first name is “DENIELLE” and not “DANIELLA”, That I used my first name
as DENIELLE in all of my records. That the above erroneous entry is a mere clerical error. Thus,
I file this petition

6) I submit the following documents to support this petition: (Use additional sheets, if necessary.)
a) My PSA copy of Birth Certificate
b) My Certified True Copy of Birth Certificate
c) My Baptismal Certificate
d) My High School Diploma
e) My College Diploma
7) I have not filed any similar petition and that, to the best of my knowledge, no other similar
petition is pending with any LCRO, Court of Philippine Consulate.
8) I am filing this petition at the LCRO of TUGUEGARAO , CAGAYAN
(City/Municipality) (Province)

in accordance with R.A. No. 9048 and its implementing rules and regulations.

DENIELLE U. BOSITO
Signature Over Printer Name of Petitioner
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VERIFICATION

I, DENIELLE U. BOSITO , the petitioner, hereby certify that the allegations

Herein are true and correct to the best of my knowledge and belief.

DENIELLE U. BOSITO
Signature over Printed Name of Petitioner

SUBSCRIBED AND SWORN to before me this 5TH day of MARCH

in the city/municipality of TUGUEGARAO , petitioner exhibiting his Community Tax Certificate
No. 24680 issued at TUGUEGARAO CITY, on MARCH 16, 2023 .
CAGAYAN

Administering Office

Doc. No.
Page No.
Book No.
Series of

For C/MCR use only

ACTION TAKEN BY THE C/MCR

Granted Denied (Provide the basis for denial.)

Date:
City/Municipality Civil Registrar

For CRG use only

ACTION TAKEN BY CRG

Affirmed Impugned

Date:
City Registrar General

CBL/11Aug01

O.R. No.:
Amount Paid:
Date Paid: