REPUBLIC OF THE PHILIPPINES )

Province of____________________) S.S.

City/Municipality of______________)
x---------------------------------------x

AFFIDAVIT OF DESISTANCE

I, SAMSON ANTIPASADO, JR., Filipino, of legal age, and a resident

of General Luna, Surigao del Norte, Philippines, after having been
duly sworn in accordance with law, hereby depose and state:

1. That I am the complainant in the criminal case filed against

JAKE GARCIA, which is recorded as Case No. _______ before
the Provincial Prosecutor’s Office - Municipality of General Luna
province of Surigao del Norte for Reckless Imprudence
resulting to Serious Physical Injuries;

2. That after pondering on the said incident, I realized that

everything happened as an accident and no one really wanted
it to happen and I have decided to withdraw my case against
JAKE GARCIA;

3. That I have executed this affidavit in order to attest to the

truth of the foregoing circumstances and that my desistance to
pursue said case is of my own free will and volition and that
there was no force, intimidation, coercion or consideration that
took place for me to make such decision.

IN WITNESS WHEREOF, I have hereunto set my hand this 22 ND day

of February, 2019 at the City of ______________.

________________________
SAMSON ANTIPASADO, JR.
Complaining Witness

SUBSCRIBED AND SWORN to before me, this

_____________, by the Affiant whom I have identified through
competent evidence of identity and who exhibited his/her I.D. No.
_____________ issued at _____________ on _____________.

_______________
Public Prosecutor