REPUBLIC OF THE PHILIPPINES

PROVINCE OF LAGUNA) S.S.

CITY OF SAN PEDRO)

AFFIDAVIT OF NO INTEREST TO FILE CRIMINAL CHARGE

I, , Filipino, of legal age, Filipino and a resident of ____ after

having been duly sworn to in accordance with law hereby depose
and state:

I was the common law spouse of ______ (Deceased).

My late common law spouse was died in an armed

confrontation against the lawmen of San Pedro Police sometime
in 2019.

I truly accepted the untimely death of my spouse ___ as it

was happened unintentionally and in the state of self
preservation on the part of the police.

In view of the foregoing, I hereby confess, declare and

manifest my lack of interest and permanent desistance from
filing any suit of whatever nature out of this incident.

I execute this statement without coercion, undue influence

and reward or any consideration.

The foregoing statements have been fully read and

translated in a dialect (Tagalog)which I understand the meaning
and importance.

I execute this affidavit to attest to the truth of the foregoing

fact and whatever legal purpose this lay serve.

In witness whereof I hereby affixed my signature this ___th

day of April 2022 in San Pedro, Laguna.

____________

SUBSCRIBED AND SWORN TO BEFORE ME this 31th day

of April, 2022 at San Pedro, Laguna. Affiant exhibited his proof of
identity indicated below his name.

Doc. No. ____;

Page No. ____;
Book No. ____;

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Series of 2022.

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