Affidavit of Discrepancy

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Republic of the Philippines )

Province of Zamboanga del Norte )


Municipality of Sergio Osmeňa ) S.S.
X----------------------------------------X

AFFIDAVIT

I, EVELYN LANTICSE ROSALES, of legal age, widow, Filipino and a resident of


Barangay Pob. Alto, Sergio Osmeňa, Zamboanga del Norte, Philippines, having been duly sworn
in accordance with law, hereby depose and state:

1. That I am the legal wife of the late, FIDEL ABAD ROSALES, a retired member of the
Armed Forces of the Philippines who passed away last September 2, 2020 at Veterans
Memorial Medical Center, North Ave, Brgy. Proj. 6, Diliman Quezon City, Metro
Manila, Philippines;

2. That in all of the pertinent records of my husband, FIDEL ABAD ROSALES, in the
Armed Forces of the Philippines, due to honest mistake, my husband was inadvertently
and erroneously recorded as having born on September 09, 1962 instead of September
09, 1960.

3. That to the best of my knowledge, my husband was born on September 09, 1960 as
evidenced by my husband’s Certificate of Live Birth, hereto attached.

4. That I am executing this Affidavit to attest to the truth of the foregoing facts and to


explain the discrepancy in all the pertinent records and/or document of my husband in the
Armed Forces of the Philippines, as regards his date of birth and for whatever legal
purpose that this affidavit may serve;

IN WITNESS WHEREOF, I have hereunto set our hands this 21 ST day of November,
2020, in Sergio Osmeňa, Zamboanga del Norte, Philippines.

EVELYN LANTICSE ROSALES


Affiant
PRC ID NO. 0561001
Valid Until 06/23/2023

SUBSCRIBED AND SWORN TO before me this 21 st day of November, 2020 at Sergio


Osmeňa, Zamboanga del Norte, Philippines, affiant exhibited to me her valid proof of identity as
above-stated.

WITNESS MY HAND AND NOTARIAL SEAL.

EARL RUSSELL S. PAULICAN


Notary Public
Until December 31, 2021
Roll No. 75530
PTR No. 2099861, 8/17/20, Dipolog City
TIN # 472-022-138
Notarial Commission No. SN: ZDN-DPL-042-2020

Doc. No.;__________
Page No.;_________
Book No.;_________
Series of 2020

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