 (Acknowledgment by Individuals - Multi-Party Instrument)

REPUBLIC OF THE PHILIPPINES)

CITY/MUNICIPALITY OF ______) SS.

ACKNOWLEDGMENT

BEFORE ME, a Notary Public for and in the (Province/City/Municipality) of _____________,

personally appeared the following persons, with their respective Community Tax Certificates as
follows:

Name C.T.C. No. Date / Place Issued

1. ____________ _______________ ________________

2. ____________ _______________ ________________
3. ____________ _______________ ________________

all known to me and to me known to be the same persons who executed the foregoing instrument
which they acknowledged to me to be their free and voluntary act and deed, consisting of only
______ (____) page/s, including this page in which this Acknowledgement is written, duly
signed by them and their instrumental witnesses on each and every page hereof.

WITNESS MY HAND AND SEAL this _____________ at _____________, Philippines.

NOTARY PUBLIC

Doc. No. ______;

Page No. ______;

Book No. ______;

Series of ______;
Republic of the Philippines)

____________________ ) S.S.

 AFFIDAVIT OF RECONCILIATION OF BIRTH DATA

I, _____________________, of legal age, single and with residence address at _____, after being

duly sworn to according to law, hereby depose and state:

1. That I am the daughter of the couple ____ and _____ of Calbayog City and I was born on May 9,
1966;

2. That in the birth certificate which I obtained only recently, my family name is spelled as
"________________" instead of "_________________" to which I have I have been used to as in my
school records, SSS, BIR and other public documents;

3.That a copy of said birth certificate which indicated my family name as "_______________" is
hereto attached for reference;

4.That the names _________________ and ___________________ belong to one and the same
person, the undersigned herein;

5. That I am executing this affidavit in order to attest to the truth of foregoing circumstances and for
the purpose of setting the records straight and declaring that ____________________and
_________________________ refer to one and the same person.

IN WITNESS WHEREOF, I have hereunto set my hand this ___day of ___________, 2013, at the
City of _____________________.

______________________

Affiant

SUBSCRIBED AND SWORN to before me this __ day of ___________ 2013, affiant exhibited a

competent proof of their Identity:

Name Govt. Issued I.D. Valid Until

__________________ _______________________ ________________

 Notary Public

Doc. No. __________;

Page No. __________;

Book No. __________;

Series of 2013.
  DEED OF DONATION

KNOW ALL MEN BY THESE PRESENTS:

That I, ______________________ of legal age, single / married to

__________________ with postal address at ______________________________
hereinafter referred to as the DONOR, and ____________________________, likewise of
legal age, single / married to _________________________________ with postal address
at ____________________ hereinafter called the DONEE, witnesseth:

That the DONOR is the registered owner of a parcel of land, more particularly
described as follows:

(Insert description of property to be donated)

That the DONEE is a cousin of the DONOR, who has lovingly dedicated five (5) years
of his life as the latter's personal caregiver and companion;

That FOR AND IN CONSIDERATION of the DONEE'S trust, devotion and affection
shown to the DONOR, and as an act of gratitude and liberality on his part, the DONOR
hereby voluntarily GIVES, TRANSFERS, and CONVEYS by way of donation, unto the said
DONEE, his heirs and assigns, the above described property, together with all the
improvements found thereon, free from all liens and encumbrances;

That the DONOR affirms that this donation is not made with intent to deceive his
creditors, and that he has reserved for himself sufficient funds and property;

That the DONEE hereby accepts and receives this donation made in his favor by the
DONOR, and hereby manifests his gratefulness for the latter's generosity.

IN WITNESS WHEREOF, both the DONOR & DONEE have hereunder subscribed their
names this __________ day of __________________ 20__ at _____________________,

Philippines.

_____________________________ ______________________________

DONOR DONEE

WITNESSES:

_______________________________ _______________________________
 ACKNOWLEDGEMENT

Republic of the Philippines)

_________________________) S.S

BEFORE ME, a notary for and in the City of Makati, personally appeared:

Name CTC Number Date/Place Issued

(Donee)
00000000 June 28, 20__ / Makati City

known to me and to me known to be the same persons who executed the foregoing Deed of Donation
and acknowledged to me that the same is their free and voluntary act and deed.

WITNESS MY HAND AND SEAL, on the date and place first above written.

Notary Public

Doc. No._____;

Page No. _____;

Book No._____;

Series of 20__.
  VERIFICATION AND CERTIFICATION OF NON-FORUM SHOPPING

I, __________________________________, of legal age, ___citizenship__________,

__status_________, and a resident of __________________________________
_______________________________________________________________________, on oath,
state:

1. That I as the __________________ in the above-entitled case have caused this

_______________________________________________ to be prepared; that I read and
understood its contents which are true and correct of my own personal knowledge and/or
based on true records;

2. That I have not commenced any action or proceeding involving the same issue and
specifically the same check/s in the Supreme Court, the Court of Appeals or any other tribunal or
agency, particularly before the Office of the City Prosecutor of
____________________________________; that to the best of my knowledge, no such action
or proceeding is pending in the Supreme Court, the Court of Appeals or any other tribunal or
agency, and that, if I should learn thereafter that a similar action or proceeding has been filed or
is pending before these courts or tribunal or agency, I undertake to report that fact to the Court
within five (5) days therefrom.

3. That I knowingly and voluntarily waive and forego the institution of any criminal
complaint for Violation of Batas Pambansa Blg. 22 against the defendant herein based on the
same check/s subject matter of this Small Claims Complaint.

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

_____________________, 20_____.

_____________________________

Affiant

SUBSCRIBED AND SWORN to before me this _________day of ______________, 20____.

NOTARY PUBLIC

Doc. No. __________;

Page No. __________;

Book No. __________;

Series of 2013.
  Notice of Appeal

(caption and title)

NOTICE OF APPEAL

COMES NOW the defendant ( or plaintiff) by the undersigned attorney and within
the reglementary period prescribed by the Rules of Court hereby files this notice of
appeal from the judgement of dismissal rendered by this Honorable Court in the above-
entitled case, dated ____________, a copy of which was received by him on ________.
_____________, ______________________, _____________. (date to)

_______________________________

(Attorney for the Complainant)

_______________________________

(Address)

Copy hereof received ________ this

___________ day of _________, ________

_______________________________

(Counsel for the Accused)