REPUBLIC OF THE PHILIPPINES)

CITY OF TALISAY ) S.S.

AFFIDAVIT OF NO INCOME

I, JUANA DELA CRUZ, Filipino, of legal age, widow and resident of Talisay, after
having duly sworn to in accordance with law, hereby depose and say, that:

1. I am the mother of Juan Dela Cruz, Filipino, 27 years old, single who is currently
detained in prison at Provincial Detention and Rehabilitation Center;

2. My spouse died a long time ago on 04 September 2012 at Bukidnon;

3. My son being detained in prison has no income not being able to engage in any gainful
employment. I, on the other hand, am not also gainfully employed and have no income as in fact,
I am solely dependent on my other child who has a family of her own.

4. I execute this Affidavit to attest the truth of the above facts for whatever legal purpose
this serves and for the purposes of obtaining a certificate of indigency and availing the services
of the Public Attorney’s Office.

IN WITNESS WHEREOF, I have hereunto set my hand this 10th day of January 2018.

JUANA DELA CRUZ

Affiant

SUBSCRIBED AND SWORN to before me this 10th day of January 2018 at Talisay City,
Philippines. Affiant exhibited to me her competent proof of identity with details indicated below
her named stated above.

WITNESS MY HAND AND SEAL on the date and place first written.

Doc. No. ____;

Page No.____;
Book No. ____;
Series of ____.