Republic of the Philippines)

Province of_________________) S.S.

City/Municipality of ____________)
x - - - - - - - - - - - - x

AFFIDAVIT OF DESISTANCE

I,__________, of legal ages, Filipino,(single /

married / widow), and a resident of ____________,
Philippines, after having been duly sworn in
accordance with law, hereby depose and say:

That I am the private complainant in the criminal

case entitled "____________"; for Theft docketed
as____________before___________Trial Court, Branch
_____,__________City, Philippines;

That I found out that the said accused at the time of

the incident was not in his right mind and did not
know that what he was doing was wrongful and criminal
considering that he was suffering from Schizophrenia,
Paranoid Type in acute exacerbation as certified to
by Dr.____________of____________;

That the items taken by the accused, consisting

of____________and____________were immediately
recovered from him and their values had been
voluntarily reimbursed by the relatives of the said
Accused;

In view of the foregoing, I finally manifest that I

now completely and absolutely exonerate the
accused__________from any liability in connection
with the above-mentioned criminal case and that I am
no longer interested, and I hereby desist, in
prosecuting the said criminal case;

That I execute this Affidavit of Desistance so that

the above-mentioned criminal case be immediately
dismissed and considered finally closed and the bond
posted by the herein accused be released to him;
As such, I am respectfully praying that the
aforementioned case against the Accused____________
be dismissed and finally closed.

IN WITNESS WHEREOF,I have hereunto set my hand

this____________at__________City, Philippines.

Affiant