REPUBLIC OF THE PHILIPPINES)

CITY/MUN. OF ____________) S.S.

Office of the Senior Citizens’ Affairs

x------------------------x

September 20, 2021

To whom it may concer:

This letter is to inform you that Gloria Elamparo Edejer, sister, (AGE) years of age, with Senior Citizen
Card #14568-S, residing at 31 Yakal Street, Barangay Amihan, Project 3, Quezon City 1101, born on April
15, 1941 and died last February 13, 2021, time of death 3:46AM, requesting a formal death notice;

I, Elizabeth Elamparo Edejer, sister, (AGE) years of age, filing in your account, enclosed the necessary
documents proving that I am the sister of deceased mentioned above and I am authorized to request
this transaction.

Thank you very much for your assistance and kind consideration. If there’s any further question please
feel free to contact on this number 09550819063.

ELIZABETH ELAMPARO EDEJER

AFFIANT

ID No.

Issued on

At

SUBSCRIBED AND SWORN to before this _________ day of __________ at ______________________.