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PROVINCE OF ANTIQUE ) SS
MUNICIPALITY OF SAN JOSE de BUENAVISTA)
AFFIDAVIT
6. That the said reply to the demand letter states the reason for the
delay in payments. The said reply also contains an attachment
representing a bank receipt of my deposit dated September 15,
2016 amounting to ₱10,000.00 as payment to the complainant
hereunto attached as Annex 3;
__________________________
abcdefg
Affiant
SUBSCRIBED and SWORN to before me, in the Municipality of
San Jose de Buenavista, Province of Antique, this 14TH day of April,
2021 by abcdefg who exhibited to me her PWD I.D. with I.D. No:1053-
123456 issued by the Republic of the Philippines on February 7, 2020.
Doc. No. _______;
Page No. ________;
Book No. _______;
Series of 20__.