REPUBLIC OF THE PHILIPPINES )

Province of ____________________ ) S.S.

City/Municipality of ______________ )
x---------------------------------------x
AFFIDAVIT OF DESISTANCE
I, ________________(name of affiant)____________, Filipino, of
legal
age,
[single]/[married
to
_________(name
of
spouse)_________],
and
a
resident
of
___________________(address of affiant)_______________, after
having been duly sworn in accordance with law, hereby depose and
say:
1.
That
I
am
the
complaining
witness
for
__________________________________________________
against _____________________________ in the case entitled
_____________________vs.____________________,
Criminal Case No. _________, ________(court branch)____;
2.
That
the
accused,
Mr/Mrs/Ms.
_________________________
have
paid
me
today
(___date___)
the
amount
of
________________________________ Pesos (Php _____).
3. That in view of the payment in full by the accused, I would
like to manifest that I am no longer interested in the prosecution
of the aforementioned criminal case.
4. I am respectfully requesting the Honorable Public Prosecutor
to move for the dismissal of the aforementioned case against
the accused, Mr/Mrs/Ms. __________________________.

(Signature of Affiant)
____________________________
(Name of Affiant)
(JURAT)
_____________________________
Public Prosecutor
[13upCD]