REPUBLIC OF THE PHILIPPINES)

MUNICIPALITY OF BOAC ) S.S.

AFFIDAVIT

I, DOMNI L. SAJO, Filipino, married, of legal age, residing at

__________________________________, after having duly sworn to in
accordance with law, hereby depose and state:

1. That I am a retired seafarer since ________;

2. That pursuant to existing laws, rules and regulations, I am not required to

file income tax return.

3. That I am executing this affidavit to attest to the truth of the foregoing.

IN WITNESS WHEREOF, I have hereunto set my hand this __ day of

February, 2016 in Boac, Marinduque.

DOMNI L. SAJO
Affiant

SUBSCRIBED AND SWORN TO before me this __ day of ___________,

2016, affiant exhibiting to me his _______ ID with No. ___________, issued on
____________ at _____________.

Doc. No.____;
Page No.____;
Book No.____;
Series of 2016.