AFFIDAVIT

 
 
REPUBLIC OF THE PHILIPPINES)
_____________________________ ) S.S. 
                                                     
 
I, ROQUE D. PALENCIA., Filipino, married, of legal age, residing at 4 th Road Hermilinda
Homes Subdivision, Brgy. Mansilingan, Bacolod City, after having been sworn in
accordance with law hereby depose and state that:

1. I am the owner of the store named

2. I promise
 
          That I took pains to look for said Certificate of Registration, but to
no avail;
 
          That I am executing this affidavit to attest to the truth of the
foregoing and to request from the Land Transportation Office of Angeles
City, a copy of said Certificate of Registration.
 
IN WITNESS WHEREOF, I have hereunto set my hand this _____ day of _______________.
20___ at _________________________.
 
                  
                   
                                                                                             (Name Over Signature
of Affiant)                                           
        
 
          SUBSCRIBED AND SWORN to before me, this ____ day of ______________, 20___
in ___________________ City, with affiant exhibiting his CTC No. _______________ ,
Issued on ______________________ at _________________________.
 
 
                                                                                               NOTARY PUBLIC
                                                                                          Until December 31,
200___
 
Doc.  No. :  ________;
Page  No. :  ________;
Book No. :  ________;
Series of 20___.