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					RA 9048 Form No.1.1 (LCRO)                                                                                                          1
(Devised 10 October 2001)
                                                          Republic of the Philippines
                                                             Local Civil Registry
                                                        Province: CAMARINES SUR
                                                        City/Municipality: TIGAON

        Republic of the Philippines}                                                            Petition No.:____________________
        Municipality of Tigaon     } s.s.


                                           PETITION FOR CORRECTION OF CLERICAL ERROR
                                                  IN THE CERTIFICATE OF LIVE BIRTH


        I,                                                     of legal age, married,              Filipino
                       (complete name of petitioner)                                            (nationality/citizenship)
        and resident of ________________________________________________________________
                                                               (complete address)
        after having been duly sworn to in accordance with law, hereby declare that:

        1. I am the petitioner seeking the correction of the clerical error in:

             a. [ ] my Certificate of Live Birth
             b. [ ] the Certificate of Live Birth of
                                                                                  (complete name of owner)
               who is my __________________________________________________________
                                                               (relation of owner to the petitioner)
        2. I /He/She was born
                                                       (Date of Birth)                            (city/municipality)
                                                            ,
                       ___________________________,____________________________________
                                          (province)                                            (country)
        3. The birth was recorded under registry number

        4. The clerical error(s) to be corrected is (are)        :                as follows

                       Item No.                   Desription
                                        Description                                      From                               To




        5. The facts/reasons for filing this petition are the following:

             For error No. 1:




    2
     6. I submit the following documents to support this petition:( Use additional sheets, if necessary)

       a)
       b)
       c)
       d)
       e)
       f)
       g)
       h)
       I)


     7. I have/He/She has not filed any similar petition and that, to th best of my knowledge,no
         other petition is pending with other LCRO, Court or Philippines Consulate.

                                                               Tigaon, Camarines Sur
     8. I am filing this petition at the LCRO of ____________________, _________________
                                                                  (city/municipaity)              (province)
        in accordance with RA 9048 and its implementing rules and regulations.




                                                                                Signature over name of petitioner




                                                       VERIFICATION

      I,                                                         petitioner hereby certify that the
allegations herein are true and correct to the best of my knowledge and belief.




                                                                  Signature over name of petitioner




     SUBSCRIBED AND SWORN to before me this                                                                    2004

                                  Tigaon, Camarines Sur        ,petitioner his Community Tax
in the city/municipality of ________________________, petitioner exhibitedexhibited his/her Community Tax
                                   issued at      Tigaon, Cam. Sur
Certificate NO. ______________issued at _________________ on _______________________.




                                                                                       Administering Officer
Doc. No.    ____________;
Page No.    ____________;
Book No.    ____________;
Series of   ____________;
public of the Philippines
 Local Civil Registry
 nce: CAMARINES SUR
 Municipality: TIGAON




ORRECTION OF CLERICAL ERROR
ERTIFICATE OF LIVE BIRTH
VERIFICATION

				
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