REPUBLIC OF THE PHILIPPINES )

CAMILING, TARLAC ) S.S

AFFIDAVIT
I, MARY SHALEE MANGLICMOT ARELLANO, 42 years old,
Filipino citizen, married, and a resident of Barangay Cabaluyan 2nd,
Mangatarem, Pangasinan, Philippines, after having been duly sworn to in
accordance with law, do hereby depose and state THAT:
1. I am the mother of JOHN MARK MANGLICMOT ARELLANO
(John Mark, for brevity), who was born on January 18, 2000;
2. John Mark, despite being a minor, begot a child named JOZIAH
AZRAEL ANTONIO ARELLANO on July 20, 2017 at the Gilberto
Teodoro Memorial Hospital, Camiling, Tarlac. The mother of the
baby boy is Jovine Santos Antonio;
3. My son John Mark voluntarily acknowledges that Joziah Azrael is his
own son and he desires to have his birth registered with the Local
Civil Registrars Office of Camiling, Tarlac;
4. I am executing this Affidavit to give my consent to the registration of
the fact of birth of Joziah Azrael Antonio Arellano;
5. Also, I am executing this Affidavit to attest to the truth of the
foregoing statements and for whatever legal intents and purposes this
may serve.
IN WITNESS WHEREOF, I have hereunto affixed my signature this
nd
2 day of August, 2017 at Camiling, Tarlac, Philippines.

MARY SHALEE M. ARELLANO

Affiant

SUBSCRIBED AND SWORN to before me on the date and place

indicated above. Affiant exhibited before me her SSS ID Card with SS No. 33-
2066431-4 issued by the Social Security System of the Philippines.

Doc. No.:________;
Page No. :_______;
Book No.:_______;
Series of 2017.