BEAUREGARD-AFFIDAVIT IN LIEU OF CERTIFICATE OF LEGAL CAPACITY TO CONTRACT MARRIAGE FOR AMERICAN CITIZENS
Republic of the Philippines)
Municipality of Bacong ) S.S.
AFFIDAVIT IN LIEU OF CERTIFICATE OF LEGAL CAPACITY
TO CONTRACT MARRIAGE FOR AMERICAN CITIZENS
I, ROBERT JOSEPH BEAUREGARD, of legal age, American citizen, and a resident of
Masaplod Sur, Dauin, Negros Oriental, under oath depose and say THAT:
1. My name is ROBERT JOSEPH BEAUREGARD, of lawful age, and I am a citizen of the United
States of America;
2. I hold a U.S. Passport No. 556292901, issued on March 9, 2017, issued at U.S. Department of State;
3. I am a legal resident of Santa Monica, California, United States of America;
4. My address in the Philippines is Masaplod Sur, Dauin, Negros Orienta, Philippines;
5. I have never been married;
6. I am applying for a license to marry FOLORAMAE SOTANA REPASO, of legal age, and a citizen
of the Philippines;
7. There is no legal impediment of any kind to the issuance of the marriage license applied for;
8. I am executing this affidavit after serious thought, without any fraud, force, intimidation, or violence
applied upon me to vitiate my consent and with full knowledge of my rights under the law to inform
authorities concerning of the veracity of the foregoing facts, and for all legal intents and purposes it
may serve.
9. I am executing this affidavit in compliance with the Memorandum Circular No. 2021-04 of the
Philippine Statistics Authority for Local or Philippine Notarization of Affidavits in lieu of Certificates
of Legal Capacity to Contract Marriage;
IN WITNESS WHEREOF, I have hereunto set my hand this July 28, 2021, in the Municipality
of Bacong, Negros Oriental, Philippines.
ROBERT JOSEPH BEAUREGARD
AFFIANT
ACKNOWLEDGMENT
SUBSCRIBED AND SWORN TO before me this July 28 2021, in the Municipality of Bacong,
Province of Negros Oriental, AFFIANT, ROBERT JOSEPH BEAUREGARD, exhibiting to me his US
Passport No. 556292901, March 9, 2017, as competent proof of his identity, known to me and to me
known to be the same person, personally signed the foregoing instrument, acknowledged to me that the
same is his free and voluntary act and deed, and avowed under penalty of law to the whole truth of said
instrument.
This instrument, with the header “BEAUREGARD-AFFIDAVIT IN LIEU OF CERTIFICATE
OF LEGAL CAPACITY TO CONTRACT MARRIAGE FOR AMERICAN CITIZENS”, consists of
only one (1) page, which includes this acknowledgement.
WITNESS MY HAND AND SEAL. NOTARY PUBLIC
Doc. No. _____;
Page No. _____;
Book No. _____;
Series of 2021