Republic of the Philippines )

C I T Y O F D I P O L O G)S.S.
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JOINT AFFIDAVIT OF NON – FILING OF INCOME TAX RETURN

We, LUZ Y. RECAMARA, single, and CHONA DALMAN-PALER, married,

all Filipinos, of legal ages, and residents of Sicayab, Dipolog City, under oath, hereby
deposeth and sayeth:

That we are the heirs of deceased Maria Y. Recamara. I, Luz Y. Recamara, her
daughter. I, Chona Dalman-Paler, as her granddaughter through my mother Luz Y.
Recamara;

That, Maria Y. Recamara did not file any Income Tax Return (ITR) previously for
the reason that she has no sufficient income;

That, we are executing this sworn affidavit in good faith, freely and voluntarily
and to attest to the truthfulness of the foregoing statement and to comply with the rules
and regulations of the Bureau of Internal Revenue, for whatever purpose it may serve;

IN WITNESS WHEREOF, I have hereunto affixed my signature this ___ day of

September, 2016 at Dipolog City, Philippines.

LUZ Y. RECAMARA CHONA DALMAN-PALER

Affiant Affiant
Senior Citizen’s ID No. 8730 ________________________
Issued 3-11-2014 ________________________

SUBSCRIBED, SIGNED, AND SWORN TO in my personal presence,

this ________________, at Dipolog City, Philippines, affiants presenting their proofs of
identity, the particulars of which are above-cited, and who avowed under penalty of law
to the whole truth of the contents of the instrument or document, which they executed
freely and voluntarily.

Doc. No. ; CLAVER A. PAJAREN

Page No. ; Notary Public
Book No. ; Until December 31, 2017
Series of 2016. PTR No. 1099102 Jan. 5, 2016
IBP No. 1032228 Feb. 24, 2016
Roll of Attorneys No. 46747 May 2, 2002
MCLE Compliance No. V – 0000375 08-15-13
SN: ZDN-DPL-016-2016