Republic of the Philippines)

CITY OF TACLOBAN . . . . . .)ss x- - - - - - - - - - - - - - - - - -x AFFIDAVIT OF DELAYED REGISTRATION OF MARRIAGE

I, AMPARO E. JACOBE, Filipino, of legal age, married and a resident of Brgy. !, "e#lamation Area, Ta#lo$an City, after %a&ing $een d'ly s(orn to in a##ordan#e (it% la(, do %ere$y depose and say) *. T%at I am t%e legal (ife of AMBROCIO A. BAJAR, JR.+ ,. T%at on June 16, 1969 (e (e-re legally married in Brgy. Tominamos, .ta. "ita, .amar and .olemni/ed $y Rev. F . !OMI"#O A. $OM%, 0aris%-0riest+ . T%at d'e to inad&erten#e and ex#'sa$le negligen#e, o'r marriage (as not registered (it% t%e Lo#al Ci&il "egistrar of .ta. "ita, .amar+ 1. T%at I am exe#'ting t%is Affi&'vit to attest to t%e tr't%f'lness and &era#ity of all t%e foregoing statements and in s'pport of t%e delayed registration of o'r marriage (it% t%e Lo#al Ci&il "egistrar of .ta. "ita, .amar. I" (I$"%)) (*%R%OF, I %a&e %ere'nto set my %and t%is 2222 day of A'g'st, ,3*, at Ta#lo$an City, 0%ilippines. AMPARO %. JACOB% Affiant )+B)CRIB%! A"! )(OR" to $efore me t%is 2222 day of A'g'st, ,3*, $y t%e a$o&e named affiant (%o presented to me a &alid identifi#ation #ard.