REPUBLIC OF THE PHILIPPINES)

PROVINCE OF LAGUNA )S.S.

MUNICIPALITY OF PAETE )

AFFIDAVIT
I, RUSSELLE CASTRO TEODORO, of legal age, Filipino and with residence
address at Sitio Pag-Ibig Pagsawitan Sta. Cruz, Laguna, after having been duly sworn to
in accordance with law, depose and state that:

1. I am the owner of a certain motor vehicle with Certificate of Registration

No. 38717737 and more particularly described as follows:

MAKE : YAMAHA
SERIES : YTX 125 BR21
MV FILE : 0401-00001191005
ENGINE NO. : E3W7E0161657
CHASSIS NO. : PA0RE3210K0161804
DENOMINATION : MOTORCYCLE WITH SIDE CAR

2. The original Denomination of said motor vehicle was “MOTORCYCLE

WITH SIDE CAR”;

3. However, I have decided to use the said motor vehicle without having the
sidecar as my personal mode of transportation from home going to work and vise versa;

4. By this, I have caused the same to change the Denomination of the said
motor vehicle from “MOTORCYCLE WITH SIDE CAR” to “MOTORCYCLE” only;

5. I further attest that the change of the denomination is not intended to any
illegal or unlawful purpose but solely due to the foregoing reasons;

6. I am executing this Affidavit to attest the veracity of my foregoing

statements and for whatever legal purpose it may serve;

AFFIANT SAYETH NAUGHT.

IN WITNESS WHEREOF, I have hereunto set my hand this 17 th day of July 2021 in
Paete, Laguna.

RUSSELLE C. TEODORO
Affiant

SUBSCRIBED AND SWORN to before me this 17th day of July 2021 in Paete,
Laguna, affiant exhibiting to me his ID with No._______________ bearing his
photograph and signature as his proof of identification.

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

Doc. No. 92;

Page No. 20;
Book No. 3;
Series of 2021.