REPUBLIC OF THE PHILIPPINES )

MUNICIPALITY OF BUGALLON ) S.S.

AFFIDAVIT OF COHABITATIVE INTENT

I, _________________, in illegal age, Bugallon, Pangasinan, after having been duly

sworn to according to law, hereby depose and state:

1. That I am the Punong Barangay of Brgy. Tambac, Malasiqui, Pangasinan with

Barangay Hall and Day Care Center located in Brgy. Tambac, Malasiqui.

2. That as said Punong Barangay I know _________________ and ________________

who were both residents of my Barangay;

3. That as Punong Barangay, I personally knew them to be living together and cohabiting
without the benefit of marriage since TWENTY FIVE (25) YEARS from the date of this
affidavit; and

4. That I am executing this affidavit in order to attest to the truth of the above
circumstances and for any purpose that it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand, together with two of my

Kagawads as witnesses on this _____ day of July 2022 at the Municipality of Malasiqui.

JUST TRYING TO BE ME
Affiant

WITNESSED BY:

_______________________ _______________________
Kagawad Kagawad

SUBSCRIBED AND SWORN to before me this _____ day of July, 2022 at the
Municipality of Bayambang, affiant personally appeared and exhibited to me his Identification
No. _________________ issued at ___________________ on _________________.

Doc. No. ________

Page No. ________
Book No. ________
Series of ________.