REPUBLIC OF THE PHILIPPINES

CITY OF WATERFALLS )S.S.

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AFFIDAVIT OF DESISTANCE

I, XXXXXXXXXXXXXXXXXXXX, of legal age, Filipino and a resident

of Purok Mabuhay, Brgy. Ngisi, Dolores, Davao del West after being duly sworn to
law do hereby depose and say:

1. That I am the Private Complainant in Ombudsman Case No.XXXX

against XXXXXXXXXXXXX, Punong Barangay, Brgy. Ngisi, Dolores,
Davao del West filed in the OFFICE OF THE OMBUDSMAN;

2. That I have lost interest in the further prosecution of the said case
against XXXXXXXXXXXXX, in this particular administrative and criminal
case based on the Affidavit Complaint that I executed dated XX July 201X;

3. That I will no longer testify in the aforesaid case for the prosecution
of his case even if called to do so by the Honorable Office and the
Honorable Court;

4. That I am requesting the OFFICE OF THE OMBUDSMAN to

DISMISS the above-mentioned case against the above-mentioned person
due to lack of interest;

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

statements without being forced, coerced, or intimidated, but out of my own
free will;

6. That the contents of this affidavit had been translated into visayan
dialect, the dialect known and understood by me.

IN WITNESS WHEREOF, I have hereunto my hand __________day of

________________, 2019 at Waterfalls City, Philippines.

XXXXXXXX XXXXXXXXX
Complainant

SUBSCRIBED AND SWORN to before me this __________ day of

__________________, 2019 at Waterfalls City, Philippines.