REPUBLIC OF THE PHILIPPINES…)

PROVINCE OF PANGASINAN.……..) S.S.

MUNICIPALITY OF MANGALDAN…)

AFFIDAVIT OF CHANGE NAME

RE: ELECTRIC METER
I, JUDITH T. PETRONA, of legal age, single, Filipino Citizen and a resident of
Brgy. Navaluan, Mangaldan, Pangasinan, after having been duly sworn to in accordance
with law, do hereby under oath deposes and says:

1. That my relatives Avelino Supremido, is the lawful and registered owner of

ELECTRIC METER under Account No. 02-15-1514-1750-0001,
Meter No. E0104957 R, installed at Brgy. Navaluan, Mangaldan,
Pangasinan, issued by Central Pangasinan Electric Cooperative, Inc.
(CENPELCO), Mangaldan, Pangasinan;

2. That I am present occupant of the constructed house which the said

electric meter was installed under the name of AVELINO SUPREMIDO;

3. That it is my desire that said electric meter and proof of billings to be

transferred under my name being the new and present owner of said
installed electric meter;

4. That I am executing this affidavit to attest to the truthfulness of the

foregoing facts and statements and for all legal intents and purposes.

IN WITNESS WHEREOF, I have hereunto set my hand this 25 th day of January

2022 at Mangaldan, Pangasinan.

JUDITH T. PETRONA
-Affiant-
NPDL No. A07-00-041608

SUBSCRIBED AND SWORN to before me this 25th day of January 2022 at

Mangaldan, Pangasinan.

Doc No. 163 ATTY. CHERISH GASMIN RUFINO

Page No. 34 Notary Public until December 31, 2022
Book No. II Roll of Attorney No. 74347/ admitted in July 09, 2020
Series of 2022 PTR No. 8673174 01/03/2022 Mangaldan, Pangasinan
IBP No. 0083 01/03/2022 Dagupan City, Pangasinan