REPUBLIC OF THE PHILIPPINES )

PROVINCE OF TARLAC ) S.S.

MUNICIPALITY OF PANIQUI )

AFFIDAVIT OF GROSS SALES

FOR THE YEAR 2017

I, VILMA P. BACARRO, of legal age, Filipino and with resident address at Barangay
Cabayaoasan, Paniqui, Tarlac, after having been duly sworn to according to law hereby depose
and state:

1. That I am the owner/proprietor of “STEFAN WATER REFILLING

STATION”, located at Barangay Cabayaoasan, Paniqui, Tarlac;

2. That my Gross Sales for the year 2017 is SEVENTY THOUSAND PESOS (Php
70,000.00), Philippine Currency;

3. That I am executing this Affidavit of Gross Sales in order to attest to the truth
and veracity of the foregoing statement and for the purpose of securing my
Business / Mayor’s Permit for the year 2018.

FURTHER, AFFIANT SAYETH NAUGHT.

IN WITNESS WHEREOF, I have hereunto set my hand this 23 rd day of February, 2018,
at Paniqui, Tarlac.

VILMA P. BACARRO
Affiant
CTC No. 28575592
Issued on February 1, 2018
Issued in Paniqui, Tarlac

SUBSCRIBED and SWORN to before me, in the Municipality of Paniqui, Province of

Tarlac, this 23rd day of February, 2018, by Vilma P. Bacarro, personally known to me and who in
person signed before me the foregoing Affidavit.

Doc. No. _____;

Page No. _____;
Book No.213;
Series of 2018