REPUBLIC OF THE PHILIPPINES)

CITY OF IMUS ) S.S.

AFFIDAVIT OF CHANGE OF COLOR OF MOTOR VEHICLE

I, SASHA GREY, of legal age, Filipino, married, and presently residing at Blk 55, Lot 66,
Ibarra Homes, Tulingan, Cavite, after having been duly sworn to in accordance with law,
depose and state:

1. I am the owner of a certain registered motor vehicle, which I inherited from my

deceased father through intestate succession, with the particular description as
follows, to wit:

MAKE: Honda
BODY: Sedan
SERIES: Civic
MODEL: 1998
PLATE NO.: UTS 101
Serial/Chassis No.: US15- 2B3509
MV FILE No.: 2477- 33438

2. I recently changed the color of the said motor vehicle from color blue to pink.

3. I therefore have executed this Affidavit to cause the necessary changes in the
registration of the above- mentioned vehicle in the Land Transportation Office, to
attest the truth I mentioned herein and for whatever legal purposes it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 30th day of January 2014 in
Imus City, Cavite, Philippines.

SASHA GREY
Affiant
Philippine Passport No. 123456
valid until January 13, 2018

SUBCRIBED AND SWORN TO before me this 30th day of January 2014 in Imus City, Cavite,
Philippines, affiant exhibiting to me her competent evidence of identity indicated below his
above- stated name.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2014.