REPUBLIC OF THE PHILIPPINES

DAGUPAN,CITY

AFFIDAVIT

I SERAFIN S.SALAZAR JR. of legal age ,married head of the family/widow to ___ and
residing at Lomboy Binmaley , Pangasinan after being duly sworn to in accordance with law ,
depose and say :

1. That ( nor my spouse ) did not file an income tax for the year 2018 for reason viz:
___________ My/Our gross income did not exceed personal and additional
exemptions ( Sec.35 NRC)
____________My/Our gross income consist solely of interest, prizes, winnings
royalties, dividends, and others reffered to under Sec.32 NIRC;
____________MY/Our income is purely compensation and the income tax on which
has been withheld ( Sec.24 (a)(1) in relation to Sec.78 (NIRC)
______________Other/s DRIVER

2. That my income for the said year is P 15,000.00 derived purely from ANNUM (and my
spouse) evidence by attached documents;

3. That should foregoing information are found to be false, I shall be liable for whatever penalty
provided in the NIRC, and to the regulations issued under authority thereof in addition to the
penalties of the perjury;

4. That this affidavit has been read and thoroughly understoodby me and it is being submitted
on my own freewill and volition to urge BIR the issuance of certification of non-filing, and for
THE SCHOLARSHIP OF MY DAUGHTER

IN WITNESS WHEREOF, I have hereunto affixed my signature on this 20th day of May 2019 at
Dagupan City,Pangasinan.

SERAFIN S.SALAZAR JR.

AFFIANT