REPUBLIC OF THE PHILIPPINES )

PROVINCE OF ORIENTAL MINDORO )S.S.

MUNICIPALITY OF ROXAS )
X-----------------------------------------------------X

AFFIDAVIT
I, MELODY INGUILLO-CAPILLO, Filipino, of legal age, married, and
with residence and postal address at Victoria, Roxas, Oriental Mindoro, after
having been sworn in accordance with law hereby depose and state that:

1. That I am the daughter of Spouses Rodrigo Dela Cruz Inguillo and

Maxima Gamo Billones;
2. That my parents got married on September 30, 1958 at Roxas,
Oriental Mindoro;
3. That my mother died on October 1, 1979 at Tauga, San Vicente,
Roxas, Oriental Mindoro and lately my father died on November 18,
2019;
4. That in my father’s Certificate of Death his civil status erroneously
entered as MARRIED instead of WIDOWER;
5. That due to inadvertence as per death certificate his middle name
was incorrectly entered as “GAMO” instead of his true and correct
name which is “DELA CRUZ” as correctly entered in his Senior
Identification Card and made an integral part hereof;
6. That Rodrigo Gamo Inguillo as per Death Certificate and Rodrigo
Dela Cruz Inguillo as correctly entered in his Senior identification
Card refers to one and the same person;
7. I am executing this affidavit to attest to the truthfulness of the
foregoing and for whatever legal purpose this affidavit may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 27 th day of

November 2019 at Roxas, Oriental Mindoro.
MELODY INGUILLO-CAPILLO
Affiant
HH ID NO. 175203007-0172-00172
Issued by Bong, Or. Mdo.

SUBSCRIBED AND SWORN to before me, this 27th day of November

2019 in Roxas, Oriental Mindoro.

Doc. No. 384; ATTY. MEYNARD H. MAGSINO

Page No. 77; Public Attorney II
Book No. XIV; Pursuant to R.A. 9406
Series of 2019.