REPUBLIC OF THE PHILIPPINES )

PROVINCE OF BULACAN ) S.S.

CITY OF MALOLOS )

A F F I D A V I T

I, TERESITA NAPOLES, of legal age, Filipino and a

resident of CSJDM, Bulacan, after having been duly sworn to
in accordance with law depose and say that:

1. I am mother of Marlon P. Napoles who passed away

recently;

2. I am seeking the aid of Provincial Government of

Bulacan to grant us financial/medical/burial
assistance for the expenses related thereto;

3. I attest that we have no other source of income

relative to the said expense;

4. The monetary assistance shall be used solely to

defray the expenses incurred as a consequence of our
situation;

5. We admittedly poor and without any source of income

to enable to answer for the attendant expenses
relative to our financial needs;

6. I am executing this affidavit to attest to the

veracity of the foregoing statements and for whatever
other purpose this may legally serve.

IN WITNESS WHEREOF, I hereunto signed this instrument on

this ______________________, here at Malolos City, Bulacan.

JEROVA ANN REY LICON

Affiant

SUBSCRIBED AND SWORN TO before me on the date and place

first above written.

Doc. No. ;
Page No. ;
Book No. ;
Series of 2020.