Republic of the Philippines )

CITY OF TACLOBAN . . . . . . . ) ss.

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

AFFIDAVIT OF DEATH BY NEAREST KIN

I, CLARA, Filipino, of legal age, widow and a resident of 363 Mabini Avenue,Brgy.
11, Pob., Catbalogan City, Samar after having been duly sworn in accordance with law
hereby depose and say:

1. That I am the wife of Edgardo Cueva Orbita who died on 12 December 2018 in
Tacloban City due to Aortic Valve Abscess and was buried on 20 December 2018;

2. That the Certificate of Death has not been registered with the City Civil Registry
Office of Tacloban City, due to inadvertence;

3. That as the nearest kin, I hereby avail of the late registration of Certificate of
Death and in the manner provided by law;

4. That this Affidavit is being executed to attest to the truth of the foregoing stated
facts for all legal intents and purposes.

IN WITNESS WHEREOF, I have hereunto set my hand this 23 rd day of January

2019 at Tacloban City.

FRANCISCA MONARBA ORBITA

Affiant
ID No. CRN-0006-2149253-4

SUBSCRIBED AND SWORN to before me this 23rd day of January 2019 at

Tacloban City.

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Page no.___
Book no.___
Series of 2019.
Republic of the Philippines )
CITY OF TACLOBAN . . . . . . . ) ss.
x------------- x

AFFIDAVIT OF DEATH BY NEAREST KIN

I, CLARA LEUTERIO VILLAMOR, Filipino, of legal age, widow and a resident of

Brgy. 83, San Jose, Tacloban City, after having been duly sworn in accordance with law
hereby depose and say:

1. That I am the daughter of VICENTE T. LEUTERIO who died on July 25, 1988 in
Tacloban City and the niece of FORTONATOT. LEUTERIO and VENANCIO T. LEUTERIO who
died on March 9, 1982 and December 6, 2008 respectively, both in Tacloban City;

2. That their Certificate of Death has not been registered with the City Civil Registry
Office of Tacloban City, due to inadvertence;

3. That as the nearest kin, I hereby avail of the late registration of Certificate of
Death and in the manner provided by law;

4. That this Affidavit is being executed to attest to the truth of the foregoing stated
facts for all legal intents and purposes.

IN WITNESS WHEREOF, I have hereunto set my hand this 23rd day of January
2019 at Tacloban City.

CLARA LEUTERIO VILLAMOR

Affiant
VIN: 3747-0342A-L1661CLV20000
Issued by COMELEC

SUBSCRIBED AND SWORN to before me this 23rd day of January 2019 at

Tacloban City.

Doc. no.___
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Series of 2019.