You are on page 1of 2


I, MR JUAN DELA CRUZ , of legal age, married and a resident of Frontier Subdivision , Bgy PUROK , CDO after having been duly sworn in accordance with law hereby state: 1.That I am the petitioner of the above instant case. 2.That I have caused the preparation of the above-entitled petition. 3.That I have read the same and that it is true and correct based on my personal knowledge or based on authentic records. 4.That I hereby certify under oath in this petition as follows: a.I have not theretofore commenced any action or filed any action or claim involving the same issue in any court, tribunal or quasi-judicial agency and, to the best of my knowledge, no such other pending action or claim is pending therein; b.If there is such other pending action or claim, a complete statement of the present status thereof ; and c.If I should thereafter learn that the same or similar action or claim has been filed or is pending, I shall report that fact within five (5) days therefrom to the court wherein the aforesaid complaint or initiatory pleading has been filed. IN WITNESS WHEREOF, I hereunto affix my signature this 12 day of July 2013 at CDO

MR. JUAN DELA CRUZ Affiant CTC No. 09177161604 Issued on January 2,2013 Issued at CDOt

SUBSCRIBED AND SWORN TO before me, a notary in and for the city named above, personally appeared the above person with his CTC, who is personally known to me to be the same and/ or identified through competent evidence of identity as defined by Rules on Notarial Practice, who presented the foregoing instrument and signed the instrument in my presence, and who took an oath before me as to such instrument. Witness my hand and seal this 12 day of July 2013

Doc. No.: 718 Page No.: 10

MARIA MAKILING NOTARY PUBLIC My commission expires December 31, 2013

Book No.:6 Series of 2013