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Affidavit of Supplemental

Mark Lisnang executed an affidavit to supplement his certificate of live birth to include his middle name of "Menes", which was omitted due to an inadvertent error by his parents. He was born on December 9, 1973 in Kapangan, Benguet to parents Holnes and Conchita Lisnang (maiden name Menes). The affidavit was notarized on December 18, 2018 in Subic, Zambales to certify the facts and serve for any legal purpose.

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192 views1 page

Affidavit of Supplemental

Mark Lisnang executed an affidavit to supplement his certificate of live birth to include his middle name of "Menes", which was omitted due to an inadvertent error by his parents. He was born on December 9, 1973 in Kapangan, Benguet to parents Holnes and Conchita Lisnang (maiden name Menes). The affidavit was notarized on December 18, 2018 in Subic, Zambales to certify the facts and serve for any legal purpose.

Uploaded by

gerrymandering
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Republic of the Philippines)

Province of Zambales) S.S.


Municipality of Subic)

AFFIDAVIT OF
SUPPLEMENTAL REPORT
I, MARK LISNANG, Filipino, of legal age, married and resident of No. 55 National
Highway, Barangay Ilwas, Subic, Zambales, Philippines, after having been duly sworn in
accordance with law, hereby depose and state:

1. That I was born on December 09, 1973 at Pudong, Kapangan, Benguet to the Spouses
Holnes and Conchita Lisnang;

2. That my birth was recorded at the Office of the Local Civil Registry of the Municipality
of Kapangan, Benguet;

3. However, it appears from my Certificate of Live Birth that I was registered therein
without a Middle Name;

4. That my Middle Name is “MENES”, the same being the maiden last name of my
mother Conchita Menes-Lisnang;

5. That it is my desire to be registered with the said Office of the Civil Registrar of the
Municipality of Kapangan, Benguet City with the Middle Name "MENES";

6. That the failure to state my Middle Name was purely the inadvertence of my parents;

7. As such, I execute this Affidavit to certify or attest to the truth of the foregoing facts
and for whatever legal purpose that this Affidavit may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 18th day of December
2018 in the Municipality of Subic, Zambales, Philippines.

MARK LISNANG
Affiant

SUBCRIBED AND SWORN TO before me this 18th day of December 2018 in Subic,
Zambales, affiant exhibiting to me his Unified Multi-Purpose ID with number CRN-0001-
1052667-8 as competent proof of his identity.

ATTY. MICHAEL JOSEPH BASA LARUTA


Doc. No. 388 ; NOTARY PUBLIC
Page No. 77 ; Until December 31, 2018
Book No. I ; Roll No. 70366
Series of 2018. IBP No. 020431/01-05018
PTR NO. Z-7020955/01-04-18
Subic, Zambales

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