Republic of the Philippines)

Province of Davao del Norte)S.S.

CITY OF TAGUM)

AFFIDAVIT
(OF DESISTANCE AND/OR WITHDRAWAL OF COMPLAINT)

I, __________________________, of legal age, Filipino, married and a resident of Visayan

Village, Tagum City, Davao del Norte, under oath, do hereby declare:

1. That, I am the private complainant in that criminal complaint docketed as NPS Docket
No. _______________________, for Malicious Mischief against
__________________________;

2. That, after due consideration of the environmental circumstances of the case, and after
dialogue with the above-named respondent/accused, I am convinced that accused did not
intend to cause damage to my property, as was out of himself – being drunk – when the
incident that gave rise to the filing of the said case took place;

3. That, respondent/accused has already paid me, to my full satisfaction, the amount of
PHP3,000.00, for the repair of my damaged property

4. That, in view thereof, I have decided to desist from further prosecuting the above-said
case, and I hereby request the City Prosecution Office of Tagum City, to cause the
withdrawal of my above-said complaint, and to cause the release of the accused, unless
he is detained for some other legal cause/s;

5. That, should the above-entitled case and/or any other case arising out of the same
incident subject of the complaint be filed in court and/or prosecuted, against the above-
named accused, I shall not stand as the private complainant therein.

6. That, should the above-entitled case be dismissed because of my declaration of desistance

and withdrawal of complaint, I shall not hold the City Prosecution Office of Tagum City,
Davao del Norte, the court or anybody, liable in any manner;

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

IN TRUTH WHEREOF, I have hereunto set my hand this ___day of May 2010 in Tagum City.

________________________________
Affiant

SUBSCRIBED AND SWORN to before me this ___ day of May 2010, in Tagum City. I hereby
certify that I have personally examined the herein affiant and am satisfied that she freely
executed this affidavit and fully understood the same.

__________________________
Government Prosecutor