REPUBLIC OF THE PHILIPPINES)

___________________________)S.S.

AFFIDAVIT OF DEATH
I, VON CHRISTIAN M. GUTIERREZ, of legal age, Filipino, single and with residence
and postal address at Casas Aurora, Brgy. tatala, Binangonan, Rizal, after having been duly
sworn to in accordance with the law, depose and say:

1. That I am submitting this affidavit to the Local Civil Registry of Morong, Rizal,
regarding the Certificate of Death of my father BAYANI C. GUTIERREZ
JR.,who died last JUNE 17, 2023 at N0. 710 T. Claudio St., Brgy. San Pedro,
Morong,, Rizal;

2. That around 9: 00 to 10: 00 in the evening my father has suffering from

difficulty of breathing , I immediately bring him to the nearest hospital but while
driving my father died and he has no pulse anymore and declared dead+;

3. That I am executing this affidavit to attest to the truth of the foregoing and to
attest to the fact that no one can be blamed for the death of my father BAYANI
C. GUTIERREZ and for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this ___ day of June, 2023 at
___________________, Philippines.

VON CHRISTIAN M. GUTIERREZ

AFFIANT
DRIVER’S LICENSE NO. N03-18-028049

SUBSCRIBED AND SWORN to before me this ____ day of June 2023 at

_____________, affiant exhibiting to me his Valid ID written below his name.

Doc No. _____;

Page No. _____;
Book No._____;
Series of 2023