Republic of the Philippines

REGIONAL TRIAL COURT

Family Court
Branch ____
First Judicial Region
Masbate City

IN RE: ADOPTION OF MINOR AND

CHANGE OF NAME OF
ROSELYN VITAL CUSPAO
TO ROSELYN SALURIA GULTIA

SP. PROC. NO._8888

SPS. ANNIE S. GULTIA and

ANTHONY A. GULTIA,

- Petitioner,

- versus-

LOCAL CIVIL REGISTRAR

OF MASBATE CITY,
- Respondent.
x------------------------------------------x

PE TI TI O N FO R AD O PT I O N

WITH ALL DUE RESPECT TO THE HONORABLE COURT

Petitioner, through undersigned counsel, unto the Honorable Court

most respectfully avers that:

1. Petitioners are husband and wife. Filipinos, both of legal age,

and residents of Unit 3 Darah-Chris Townhouse 2, Barangay
Nursery, Masbate City, where she may be served with
notices, summons, orders and other court processes;

2. The respondent, the Local Civil Registrar of Masbate City is

herein impleaded as a nominal party; the government office
tasked to implement whatever order/s that the Honorable
Court may issue relative to this case. Notices, orders,
summons and other court processes maybe served to said
office at the Masbate City Hall;

3. The petitioners have no legitimate children or descendants

and hereby desire to jointly adopt a minor child named

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 ROSELYN VITAL CUSPAO, three years of age, Filipino,
and likewise residing at Barangay Nursery, Masbate City;

4. The herein subject minor, was born at Masbate City

Provincial Hospital on January 5, 2014 to Espie Vital Cuspao,
unmarried, which proof of birth was duly registered in the
Register of Births of the Office of the Civil Registrar of
Masbate City, for which a Certificate of Live Birth was
issued. A machine copy of it is herewith attached as Annex
A;

5. The biological mother of the minor child has no stable means

of livelihood with which to support her childs basic, as well
as essential needs. Her circumstances being so, and for the
best interest of the minor child, she had left her child under
the care of the petitioners and had consented for her child to
be adopted by the herein petitioners. Copy of her Affidavit of
Consent is hereto attached as Annex B;

6. Such circumstance of the biological mother did not however

hinder her in making occasional visits at the home of the
petitioner to see how her child was doing;

7. Since the time ROSELYN was brought to the house of the

petitioners, the latter had been the ones acting as mother and
father to the child; giving her basic necessities, care, comfort
and love. They had provided her a home; a safe and secure
environment for her to grow up in;

8. Espie Vital Cuspao is neither insane, nor intemperate. Neither

did she abandon her minor child, and she possess full
knowledge of petitioners intention to adopt her minor child
and had expressly given her consent to this adoption;

9. The minor sought to be adopted does not own any real,

personal, tangible and intangible property;

10. As per Child Study report, the DSWD has evaluated and
recommended that the minor child can be legally adopted to
spouses ANNIE S. GULTIA and ANTHONY A. GULTIA for
the childs best interest and welfare. A copy of said DSWD
Child Study Report is herein attached as Annex C;

11. The petitioners are qualified under the law to adopt a child;

12. They are in possession of all civil and legal rights, and have
not been convicted of any crime involving moral turpitude;

13. The petitioners are of good character, has no derogatory

record whatsoever can be attributed to them, are emotionally

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 and psychologically capable of caring for the child, are more
than sixteen (16) years older that the subject minor sought to
be adopted, are in position to support and care said child in
keeping with the means of the family;

14. The adoption is for the best interest and security of the said
minor if he would be considered as true and legal child of
herein petitioners and it will make his life normal, productive,
and good persons in the community;

P R AYE R

WHEREFORE, it is most respectfully prayed that after due

notice and hearing, judgment be rendered adjudging the minor child,
ROSELYN VITAL CUSPAO, freed from all legal obligations of
obedience and maintenance with respect to her natural parents and
that she be declared to all legal intents and purposes, the child of the
herein petitioners, and that her name follow that of the petitioners,
thus ROSELYN SALURIA GULTIA.

Masbate City, Philippines, this 6TH day of January 2017.

ATTY. HILDA ANGELIE BERNAL

Counsel for the Petitioner
Corner. Rosero & Quezon Streets,
Masbate City Masbate
IBP No. 812888; 01/04/2017
PTR No. 1218888; 01/04/2017
Roll No. 88811; 05/05/2005
MCLE No. 888808

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REPUBLIC OF THE PHILIPPINES )
City of Masbate ) S.S.

VERIFICATION and CERTIFICATION

We, Spouses ANNIE S. GULTIA and ANTHONY A. GULTIA,

both of legal age, Filipino citizens, and residents of Unit 3 Darah-Chris
Townhouse 2, Barangay Nursery, Masbate City, under oath, depose and
state:

1. That we are the Petitioners in the above-mentioned case;

2. That we have caused the preparation of this Petition;

3. That we have read and understood its contents and affirm that they are
true and correct to our personal knowledge and based on authentic records;
and,

4. That we hereby certify that there is no other case or special proceeding

commenced or pending before any court involving the same parties and the
same issue and that should we learn of such a case or special proceeding, we
shall notify the court within five (5) days from our notice.

IN WITNESS WHEREOF, we have signed this instrument on the

4th day of January 2017, in the City of Masbate, Philippines.

ANTHONY A. GULTIA ANNIE S. GULTIA

Affiant Affiant

SUBSCRIBED AND SWORN TO before me this 6th day of January

2017 at Masbate City, Philippines, the person being personally known to me
to be the same person who executed the foregoing document.

ATTY. HILDA ANGELIE BERNAL

Notary Public for Masbate City
Corner. Rosero & Quezon Streets,
Masbate City Masbate
IBP No. 812888; 01/04/2017
PTR No. 1218888; 01/04/2017
Roll No. 88811; 05/05/2005
MCLE No. 888808

Doc. No.___2_;
Page No. __5__;
Book No.__1__ ;
Series of 2017_

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REPUBLIC OF THE PHILIPPINES)
BAGUIO CITY ) S. C.

AF F I D AV I T O F CONSENT

I, MAURA MING HANAQUE, of legal age, single, Filipino citizen

with residence and postal address at 45 2 nd Road, Quezon Hill, Baguio City,
after having been duly sworn to in accordance with law, do hereby depose
and state that:

1. I am the biological mother of one QUEENIE ELSA HANAQUE

who was born on January 28, 2004 in Baguio City;

2. I was not married when I gave birth to LIEZETTE JOY;

3. My friend, UNICA E. HAYA, had helped me greatly in raising my

minor child and had expressed her desire to adopt my said child;

4. I am not insane, nor intemperate, nor have I abandoned said minor

child. I have full knowledge of the intention of UNICA E. HAYA
to adopt my minor child and having the best interest of my child in
mind, I have consented to the adoption;

5. I am aware of the fact that once QUEENIE ELSA HANAQUE

will be adopted, I shall lose ALL parental authority and that she
will become the legal child of UNICA E. HAYA;

6. I am executing this AFFIDAVIT OF CONSENT freely and

voluntarily to attest to the truthfulness of my foregoing statements
and circumstances; to prove and show that I am giving my
consent to the adoption of my minor child QUEENIE ELSA
HANAQUE by UNICA E. HAYA and for all other legal intents
and purposes it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 6 th day

of July 2015 at Baguio City, Philippines.

MAURA MING HANAQUE

Affiant

SUBSCRIBED AND SWORN TO BEFORE ME this 6 th day of July

2015 at Baguio City. The Affiant exhibited to me her BIR TIN ID Card with
TIN ID 293-464-775-000 issued in Baguio City on September 14, 2011

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indicated below her name and signature. She acknowledged to me that the
same is her free and voluntary act or deed.

WITNESS MY HAND AND SEAL.

ATTY. YVETTE KATHRYN S. BARRIENTOS

Notary Public for Baguio City
Appointment No. 923, Until Dec. 31,2016
2F Units 03-04 VMOZR Bldg., Harrison
Rd., Baguio City
IBP No. 812923; 01/01/2015 Baguio
Doc. No.______; PTR No. 1211016; 01/01/2015 Baguio
Page No. ______; Roll No. 70522; 05/05/2005
Book No.______; MCLE No. 110508
Series of 20___.

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