Republic of the Philippines }

Dumaguete City }
Province of Negros Oriental } S.S.

AFFIDAVIT

I, PATRIA CABRERA FORTICH, of legal age, Filipino, widow and a resident of Purok Crosstac, Barangay
Taclobo, Dumaguete City, Negros Oriental, Philippines after having been duly sworn to in accordance with law, hereby
depose and say,

1. I am 92 years of age, a natural-born Filipino citizen, born at Dumaguete City, Negros Oriental on May 14,
1930 to Filipino parents, namely: Pastor Cabrera and Tarcela Cabrera; still residing at Purok Crosstac,
Barangay Taclobo, Dumaguete City, Negros Oriental, Philippines;

2. I was married to Ricardo Sindiong Fortich, also a natural-born citizen, born at Dumaguete City, Negros
Oriental on May 12, 1928 to Filipino parents, namely: Ricardo Fortich Sr. and Juliana Sindiong Fortich.

3. I and my late husband Ricardo Sindiong Fortich, was a resident at Purok Crosstac, Barangay Taclobo,
Dumaguete City, Negros Oriental for more than 15 years, to confirm a Baraggay Certification was issued
by the Hon. Roger E. Bohol on November 28, 2022 at the office of the Punong Baranggay Brgy Hall of
Tacolobo, Dumaguete City, Negros Oriental, Philippines; “Annex A”;

4. THAT my late husband Ricardo Sindiong Fortich was a retired government employee of the Philippines,
was an Operations Manager at National Food Authority Negros Oriental Branch Office with a permanent
status as since April 1, 1963 until his retirement date on May 12, 1993 based on his service record “Annex
B” and certification obtain at GOVERNMENT SERVICE INSURANCE SYSTEM (GSIS) “Annex C”;

5. THAT Ricardo Sindiong Fortich was a taxpayer with a permanent Tax Account Number (TAN) 1229-
029-2. based on the document found during his filling of his firearms registration “Annex D”; That on
Estate Tax computation, confirmation and payment was registered with Tax Identification Number 617-
659-051-0000 last November 8, 2022, attached is BIR Form NO. 1904 with stamp and date of received by
an Revenue Officer “Annex E”;

6. I and my late husband Ricardo Sindiong Fortich, after his retirement from work we were traveling very
often to the United States of America back and forth to visit for a vacation at our daughter home and other
family relative members.

7. On May 6, 2010 my husband Ricardo Sindiong Fortich died at Ronald Reagan UCLA Medical Center, Los
Angeles, California, USA of Stroke. At filling of his death certificate by our daughter Elsie Fortich Ahrens
it was stated on the form on the decedent’s personal data for “USUAL OCCUPATION as Operations
Manager and Government because upon on the instruction “TYPE OF WORK FOR MOST OF LIFE.
DO NOT USE RETIRED” and “KIND OF BUSINESS or INDUSTRY” referring to his previous
work in the Philippines as a retired government employee “ANNEX F”;

8. I am executing this affidavit to attest to the truth of the foregoing facts in support to the required document
needed as per request by a Revenue Officer/Examiner for the computation of ESTATE TAX of my late
husband Richard Sindiong Fortich at the Bureau of Internal Revenue (BIR) Revenue District Office No.
079 Dumaguete City.

IN WITNESS HEREOF, I have hereunto signed my name below this December 6, 2022, in Dumaguete
City, Negros Oriental, Philippines.

PATRIA C. FORTICH
Affiant
Senior Citizen ID No. 12504

SUBSCRIBED AND SWORN TO BEFORE ME, this ________________, in Dumaguete City, Negros
Oriental, Philippines

Doc. No. ______;

Page No. ______;
Book No. ______;
Series of 2022