Republic of the Philippines
REGIONAL TRIAL COURT
Second Judicial Region
BRANCH 22
Cabagan, Isabela
IN RE: PETITION FOR CHANGE OF FIRST
NAME FROM DOMINGO TO DOMINADOR
AND CORRECTION OF ENTRY IN THE
CERTIFICATE OF LIVE BIRTH OF
DOMINGO TAN FUGABAN REGISTERED
UNDER LOCAL CIVIL REGISTRAR NO. 298,
DOMINADOR TAN FUGABAN,
Petitioner,
-versus- Special Proceeding No. 22-1346
THE LOCAL CIVIL REGISTRAR OF
CABAGAN, ISABELA, and
THE CIVIL REGISTRAR GENERAL,
NATIONAL STATISTICS OFFICE,
Respondents.
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PETITION
Comes now the Petitioner, through the Public Attorney's Office, unto this Honorable
Court respectfully alleges the following:
1. Petitioner is of legal age, Filipino, married and a resident of Casibarag Norte, Cabagan,
Isabela. He may be served with Orders, notices, and other court processes of the
Honorable Court at the said address; Respondents are government functionaries tasked
with the keeping, among others, of birth records. The Local Civil Registrar of Cabagan,
Isabela is holding office at the Municipal Hall, Cabagan, Isabela, while the Civil
Registrar General, National Statistics Office is holding office at 2F Vibal Bldg., Times
St., corner EDSA, Quezon City, where they may be served with notices and processes of
this Honorable Court;
2. Recently, Petitioner secured a copy of his Certificate of Live Birth from the National
Statistics Office and he discovered that there are erroneous entries therein. The aforesaid
Certificate of Live Birth is hereto attached as Annex A. Petitioner found out that his first
name was erroneously entered as DOMINGO instead of DOMINADOR and his date of
birth was indicated therein as 5-25-63 which means May 25, 1963 instead of his true date
of birth which is May 5, 1963;
3. Petitioner is absolutely and definitely sure that the aforesaid Certificate of Live Birth with
Local Civil Registrar No. 298 registered before the Local Civil Registry of Cabagan,
Isabela, is his considering that all other data contained therein pertain to his personal
information except to the aforesaid erroneous entries. Hence, this Petition;
4. Petitioner alleges that he never used the first name “DOMINGO”. From childhood to
present, Petitioner has been using the name “DOMINADOR”. To prove this fact, attached
are the following: the Isabela Provincial Health Card of the Petitioner issued by the
Provincial Government of Isabela, his Unified Multipurpose ID issued by the
Government Service Insurance System, and his identification card as Barangay Kagawad
issued by the Department of the Interior and Local Government, hereto marked as Annex
B, Annex C, and Annex D, respectively.
5. A perusal of the aforesaid documents shows that the first name of the Petitioner is
DOMINADOR and not DOMINGO and his date of birth is May 5, 1963 and not May 25,
1963;
6. Considering the foregoing premises, Petitioner herein seeks for the correction of the
foregoing entries in his Certificate of Live Birth in order to avoid confusion and to set
straight his birth record and not for any purpose contrary to law;
PRAYER
WHEREFORE, it is most respectfully prayed of this Honorable Court that after due
notice and hearing, a Decision shall be rendered directing the Local Civil Registrar of Cabagan,
Isabela and the National Statistics Office to effect the change of the First Name of the Petitioner
from DOMINGO to DOMINADOR and his date of birth from 5-25-63 to May 5, 1963 in his
Certificate of Live Birth under Local Civil Registrar No. 298 registered before the Local Civil
Registry of Cabagan, Isabela.
Other reliefs just and equitable are likewise prayed for.
Cabagan, Isabela, this 3rd day of January, 2013.
DEPARTMENT OF JUSTICE
PUBLIC ATTORNEY’S OFFICE
Cabagan District Office
Cabagan, Isabela
By: TEDDY G. DELA CRUZ
Public Attorney
Counsel for Petitioner
Roll No. 54115
Lifetime IBP No. 06632/Cagayan
MCLE No. III-0020714/ June 15, 2011
VERIFICATION/CERTIFICATION
I, DOMINADOR T. FUGABAN, of legal age, Filipino, married and a resident of
Casibarag Norte, Cabagan, Isabela, after duly sworn to in accordance with law, hereby
depose and state that:
a. I am the petitioner in the above-entitled case;
b. I have caused the preparation of the foregoing petition according to the best of
my knowledge, have read and understood the same; and all the contents therein
are true and correct to the best of my knowledge and beliefs;
c. I certify that I have not commenced any action involving the same or similar
issues before any court, quasi-judicial body, tribunal or agency within the
Philippines; to the best of my knowledge, no such other action or claim is
pending therein; and should I learn that any similar or same action has been filed
or is pending, I undertake to notify this Honorable Court within five ( 5) days from
notice thereof.
IN WITNESS WHEREOF, I have hereunto affixed my signature this 3 rd day of
January, 2014 at Cabagan, Isabela.
DOMINADOR T. FUGABAN
Affiant
GSIS ID No. CRN-0111-1799081-1
SUBSCRIBED AND SWORN to before me by the affiant who is personally known
to me on the date and place above-written.
TEDDY G. DELA CRUZ
Public Attorney
