AFFIDAVIT OF GUARDIANSHIP

I, HELEN L. MARIÑAS, of legal age, widow, Filipino citizen, with

residence and postal address at Blk 4 Lot 8 St. Peter St., St. Francis Homes 8 Subd.,
Brgy. Pooc, City of Santa Rosa, Laguna, after having been sworn in accordance with
law hereby depose and state:

1. That I am the mother and legal guardian of JAZMINE CLAIRE L.

MARIÑAS born on July 11, 2004 at City of Santa Rosa, Laguna;

2. She is the natural child of late HENRY BERT V. MARIÑAS who died on
May 8, 2020 at Community Hospital, City of Santa Rosa, Laguna;

3. That since her father died, I am the one taking care of her and she was in
my custody;

4. That I am executing this affidavit to attest to the truth of the foregoing

statements and for compliance with the requirements for death claim of my
late husband HENRY BERT V. MARIÑAS at OWWA office and for
whatever legal purpose it may serve;

5. Further, I sayeth none.

IN WITNESS WHEREOF, I have hereunto signed my name this 13 th day of

July, 2020 at the City of Santa Rosa, Laguna.

HELEN L. MARIÑAS
Affiant

REPUBLIC OF THE PHILIPPINES )

CITY OF SANTA ROSA LAGUNA )S.S.

SUBSCRIBED AND SWORN TO before me this 13 th day of July, 2020, affiant

exhibiting to me her UMID ID No. CRN-006-0097-2622-4 issued at City of Santa
Rosa, Laguna.

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

ATTY. BLESSIE ROSE CARPENA

Doc. No. ____ Notary Public
Page No. ____ Until December 31, 2020
Book No. ____ Roll No. 64719
Series of 2020 IBP No. 098536 (01/15/19)
PTR No. 3930174 (01/02/2020)
MCLE Compliance V-0021577
City of Santa Rosa, Laguna