REPUBLIC OF THE PHILIPPINES)

BACOLOD, LANAO DEL NORTE) S.S.

AFFIDAVIT OF GUARDIANSHIP

I, MERLYN SUMILE DELA CRUZ , of legal age, Filipino

citizen, married to MICHAEL D. DELA CRUZ and residing at
Pagayawan, Bacolod, Lanao del Norte after having been sworn
in accordance with law hereby depose and state:

1. That I am the a distant relative and the guardian of

Adriana Lomosad, an infant born on April 9, 2018 at
Demologan, Bacolod, Lanao del Norte;
2. That the said minor is under my care and custody;
3. That from the time the child was born, I provide the
basic needs of the child, including her food,
clothing and shelter, In addition, I and together
with my family provides emotional and other needs of
the child;
4. That the father of the said minor is unknown and the
mother, Renalyn S. Dela Cruz is financially incapable
of providing support to the said minor;
5. That I am executing this affidavit to attest to the
truth of the foregoing and other legal purposes this
affidavit may serve.

Affiant Further Sayeth Naught

IN WITNESS WHEREOF, I have hereunto set my hand this

30th day of August 2018 at Bacolod, Lanao del Norte.

MERLYN SUMILE DELA CRUZ

Affiant
__________________________
Bacolod, Lanao del Norte

SUBSCRIBED AND SWORN TO before me, this 30th day of August

2018 at Bacolod, Lanao del Norte.

ATTY. ALFONS JANSSEN P. MARCERA

Doc. No. : ________;
Page No. : ________;
Book No. : IV;
Series of 2018.
Notary Public
Serial No. 17-152
Iligan City- Lanao del Norte
Until December 31, 2018
IBP Lifetime No. 01840
Roll No. 70427- July 31, 2017
PTR No. 3520052-12/31/18
MCLE 2016 waiting for MCLE Certificate