Affidavit of Informant LAZAGA

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Republic of the Philippines)

City of Butuan ) S.S.

X-----------------------------------/

AFFIDAVIT OF INFORMANT

I, AVELINA P. LAZAGA, of legal age, Filipino, married, and a resident of P-20,


Barangay San Vicente, Butuan City, after having been duly sworn to in accordance
with law, do hereby depose and state:

1. I am the grandmother of RHEA MAY LAZAGA, who was born on December 24


2003 at Agusan del Norte Provincial Hospital, Butuan City to EMALYN PEREZ
LAZAGA;

2. I am the one processing the application for Late Registration of Birth of the
aforementioned because her mother is currently working in Manila and does not
have the time to do the same;

3. That the child was born out of wedlock;

4. The child’s birth was attended by EVELYN E. DURON, a Medical Doctor of Agusan
del Norte Provincial Hospital, Butuan City;

5. That her birth was not registered within 30 days from the time of the child’s birth
due to negligence and financial constraints;

6. I am executing this affidavit to attest to the veracity of the foregoing and to


support the application for Late Registration of Birth of the child, RHEA MAY
LAZAGA.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 3rd day of


October 2019 at Butuan City, Philippines.

AVELINA P. LAZAGA
Affiant
OSCA: 8600-38586

SUBSCRIBED AND SWORN TO BEFORE ME this 3rd day of October 2019 at Butuan
City, Philippines.

Doc. No. ________;


Page No. ________;
Book No. _________;
Series of 2019

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