REPUBLIC OF THE PHILIPPINES )

PROVINCE OF NUEVA VIZCAYA ) S. S.

MUNICIPALITY OF BAMBANG

AFFIDAVIT OF LOSS

That I, TONY REY V. MIÑA, JR., of legal age, married, Filipino citizen and resident of
San Leonardo, Bambang, Nueva Vizcaya, and Traffic Enforcer of the Municipality of Bambang,
after having been duly sworn to in accordance with law, do hereby despose and declare to wit;

1. That I am a holder of Citation Ticket # 14301-14350, issued at Municipal

Treasurer’s Office of the Municipality of Bambang, Nueva Vizcaya;

2. That said Citation Ticket was kept in my pocket; however, on my way back home,
when I tried to check on it, I found out that the said Citation Ticket was missing
and inadvertently dropped;

3. That I, together with some members of the family have exerted diligent efforts to
locate said Citation Ticket, but all our efforts proved futile and useless; hence, I
considered it NOWHERE TO BE FOUND and is already beyond recovery;

4. That I am executing this affidavit freely and voluntary to attest to the truth and
veracity of the foregoing statements.

IN WITNESS HEREOF, I have hereunto set my hand this 20 th day of November, 2020 at
Bambang, Nueva Vizcaya.

TONY REY V. MIÑA, JR.,

(Affiant)
LGU I.D. #. 10381
Issued at: Bambang, N.V.

SUBSCRIBED AND SWORN to before me this 20 th day of November, 2020 at

Bambang, Nueva Vizcaya.

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Series of 2020