7/23/2019 Affidavit of Acknowledgement With Authority to Use
Surname
1/1
REPUBLIC OF THE PHILIPPINES)CITY OF MANILA
)S.Sx---------------------------------------------x
A F F I D A V I T(of acknowl!"#n$ an! a%$&o'$ $o %*
*%'na#)
I, AUDIE B. ++++++++, of legal age, Filipino and presently
residing at2648 M. Hizon, Sta. Cruz, City of Manila, after haing
!een duly s"orn to ina##ordan#e "ith la" here!y depose and state
that $
%. &hat ' a( the legal and !iologi#al father of ALYANA
________, whowere born on June 14, 1992, at )ose Fa!ella Me(orial
Hospital inManila fro( one *elyn C. Fran#is#o+
2. nd as the !iologi#al father of Alana +++++, ' a( freely and
"illingsupporting her+
. &hat ' here!y ,a%$&o'-n" Alana +++++++ to use
(ysurna(efa(ily na(e as proof of our relationship and
paternity,pursuant to /epu!li# #t 0o. 12also 3no"n as An Act
AllowingIllegitimate Children to Use the Surname of their
Father+
4. &hat ' a( exe#uting this ffidait to attest to the era#ity
of the
foregoing and for any legal purpose it (ay sere.
IN WITNESS WHEREOF, ' here!y set (y hand this 55 day of pril
2%2in the City of Manila.
AUDIE B. +++++++++Affan$
SUBSCRIBED AND SWORNto !efore (e this 5555 day of pril 2%2 inthe
City of Manila.
7o#. 0o. 55555+age 0o. 55555+9oo3 0o. 55555+Series of 2%2
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