Republic of the Philippines

REGIONAL TRIAL COURT

Family Court
Branch 48
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,
- versusLOCAL 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;

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13.

The petitioners are of good character, has no derogatory

record whatsoever can be attributed to them, are emotionally
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
Affiant

ANNIE S. GULTIA
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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