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Republic of the Philippines

FIRST JUDICIAL REGION


REGIONAL TRIAL COURT
Branch 2
Tabuk City

In the Matter of:


CORRECTION OF ENTRY IN THE
CERTIFICATE OF LIVE BIRTH OF
ADRIAN ALBAYTAR TO ADRIAN
ALBAYTAR KALAW,

Petitioner, SPECIAL PROCEEDING


CASE NO. _______
-versus-

THE LOCAL CIVIL REGISTRAR


OF LIPA CITY,

Respondent.

X ------------------------------------------------------------ x

PETITION

WITH ALL DUE RESPECT TO THE HONORABLE COURT, the


Petitioner, through counsel, and unto the Honorable Court, states that:

1. The petitioner is of legal age with postal address at Brgy. Kayumangi,


Lipa City.

2. The Local Civil Registrar is a government entity charged with the


recording, registration, and custody of public records and other matters,
with postal address at the
___________________________________________________

3. Petitioner was born on MARCH 8, 1996, and is the natural child of


ALICIA ALBAYTAR KALAW and RENE RIVERA KALAW. Said
birth was duly registered with the Local Civil Registry under Local Civil
Registry No. 96-1349. A machine copy of the Certificate of Live Birth is
hereto attached as Annex “A”, to form part hereof;
4. In the said Certificate of Live Birth, Petitioner’s Last name is
ALBAYTAR, the surname of his mother;

5. The same Certificate of Live birth, also indicates that his birth parents are
NOT MARRIED, during the time of his birth. Hence, making him an
ILLEGITIMATE CHILD.

6. Eventually, there was a subsequent marriage between his parents on


DECEMBER 8, 1999 at OUR LADY OF THE MIRACULOUS MEDAL
CHAPEL, as evidenced by a CERTIFICATE OF MARRIAGE hereto
attached as Annex “B”.

Moreover, several entry is incorrect, and said information was erroneously


entered by the attending medical clerk at the hospital. The clerical error(s) to
be corrected is (are):

ITEM NO. DESCRIPTION FROM TO


MOTHER’S ALICE ALICIA
1 MAIDEN NAME ALBAYTAR ALBAYTAR
RENE RIVERA
2 FATHER’S NAME RENE KALAW KALAW
MARRIAGE OF
3 PARENTS NOT MARRIED MARRIED

7. The errors was made due to mistake of fact, supplied in good faith and
without any unlawful or illegal intention;

8. The Correction being sought is meant to state the truth of (1) his Surname,
(2) his mother’s full maiden name,(3) his father’s full name, and (4) his
parent’s marriage.

PRAYER

WHEREFORE, premises considered, it is most respectfully prayed of


the Honorable Court that, after due notice and hearing, a decision be rendered
in favor of herein Petitioner, ordering the Local Civil Registrar of the City of
Lipa to change the entry in Petitioner’s Certificate of Live Birth under the –
(1) FULLNAME OF PETITIONER from “ADRIAN ALBAYTAR” to
ADRIAN ALBAYTAR KALAW;
(2) MOTHER’S MAIDEN NAME from “ALICE ALBAYTAR” TO
ALICIA ALBAYTAR
(3) FATHER’S NAME from “RENE KALAW” to “ RENE RIVERA KALAW”
(4) MARRIAGE OF PARENTS from “NOT MARRIED” to
“MARRIED”.

Such other reliefs as may be just and equitable under the circumstances
are likewise prayed for.

IN WITNESS WHEREOF, I have hereunto set my hand this day of


_____________________, in the City of Lipa, Batangas, Philippines.

ATTY. JILLIAN KRISTIN DEVESA


Counsel for the Petitioner

REPUBLIC OF THE PHILIPPINES }


CITY OF LIPA } S.S.
X ========================== X

VERIFICATION AND CERTIFICATION AGAINST FORUM SHOPPING

I, ADRIAN ALBAYTAR KALAW, of legal age, Filipino citizen, and


hereby declare under oath that:

1. I have caused the preparation of the foregoing petition; I have read and
understood the contents of the same; and that all the allegations therein are true
and correct of our own knowledge and based on authentic documents;

2. I FURTHER CERTIFY THAT:


a. I have not commenced any proceeding involving the same issues before
the Supreme Court, Court of Appeals, or any other Government Agency
or Tribunal;
b. To the best of our knowledge, no such action is pending before the
Supreme Court, Court of Appeals, or any other Government Agency or
Tribunal;
c. If there be any similar action before the Supreme Court, Court of Appeals,
or any other Government Agency or Tribunal, We undertake to report the
same within five (5) days to the court where the original action and
certification referred to herein has been filed.

IN WITNESS WHEREOF, I have hereunto set my hand this day of


__________________, in the City of Lipa, Batangas, Philippines.

ADRIAN ALBAYTAR KALAW

SUBSCRIBED AND SWORN to before me in the City of Baguio this 5th day
of _______________, by affiant personally known to me, who are the same person
who personally signed before me the foregoing affidavit and acknowledged that she
executed the same.

Doc. No. __;


Page No. __;
Book No. __;
Series of 2019.