REPUBLIC OF THE PHILIPPINES)
________ CITY ) SS.
I, ________________, Filipino, of legal age, with address at __________________________________, after having been sworn to in accordance with law hereby depose and state that:
2. ] STATE THE FACTS!
4. I herein attest to the truthfulness of the foregoing facts.
AFFIANT FURTHER SAYETH NAUGHT.
IN WITNESS WHEREOF, I hereby affix my signature this ___ day of __________200__ in ___________ City.
SUBSCRIBED AND SWORN to before me, a Notary Public, this ___ day of ____________ 200__ at _____________ City, affiant exhibited to me his Community Tax Certificate No. ____________ issued on ______________ at ______________.
Doc. No. ;
Page No. ;
Book No. ;
Series of 200_.