Republic of the Philippines)

Pasay City

) S.S.

AFFIDAVIT FOR DELAYED REGISTRATION OF BIRTH

I, Cecilia Magnayi Peatman, widow, presently residing at Mataas na
Lupa, San Pascual, Batangas, after being duly sworn in accordance with law,
hereby depose and say that:
1.
That I am the applicant for the delayed registration of the birth of
Kevin Magnayi Peatman;
2.
That he was born on March 21, 1992 at Dallas/Fort Worth Medical
CenterGrand Prairie Tarrant Texas;
3.
That he was attended at birth by Michael McCullough who resides
at 2705 Hospital Blvd #201 Grand Prairie Texas, 75051;
4.

That he is a citizen of United States of America;

5.
That his parents were Leo Milton Peatman and Cecilia Magyani
Peatman married on March 16, 1990 at Las Pinas City, Philippines;
6.
That the reason for the delay in registering his birth was because I
am unaware that I have to register his birth at a Philippine consulate;
7.

That I am the mother of the said person.

8.
That I am executing this affidavit to attest to the truth and veracity
of the foregoing facts and in compliance with the requirements of the Department
of Foreign Affairs.
AFFIANT FURTHER SAYETH NAUGHT.
IN WITNESS WHEREOF, I have hereunto set my hand this ___ day of
June __ 2016 at Pasay City.
Cecilia Magnayi Peatman
Affiant
SUBSCRIBED AND SWORN to before me this ___ day of June 2016, at
Pasay City, affiant exhibiting to me her Passport with number 538629524, thus
satisfactorily having proven her identity to me.
Doc. No. ___
Page No. ___
Book No. ___
Series of 2016.