Republic of the Philippines )

Davao del Norte ) S.S.

City of Tagum )
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AFFIDAVIT OF LEGAL GUARDIAN

I, TERESITA MARA, of legal age, Filipino, and a resident of Purok 1

Poblacion, Mawab, Davao de Oro, after having been duly sworn to in accordance
with law, hereby depose and state, that:

1. I am the legal guardian of Karen Cerna, 17 years of age;

2. Karen is an orphan since the death of her parents;

3. Since the time of her parents’ death, I stood up as the latter’s guardian;

4. I am left alone with the sole responsibility of parenthood, providing

for the needs of Karen and taking care of her;

5. I am a competent guardian and I am not an imbecile, insane, a vagrant

or vicious person or a habitual drunkard or a habitual criminal, and
have not abandoned, neglected or refused to support my family; and

6. I am executing this affidavit to attest to the truth of the foregoing facts,

and for whatever legal purpose this may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this

___________________ at Tagum City, Davao del Norte, Philippines.

TERESITA MARA
Affiant/NATL ID:2096-7325-0290-7261

SUBSCRIBED AND SWORN to before me on ______________ affiant

exhibiting to me sufficient evidence of her identity.

WITNESS MY HAND AND SEAL.

Doc. No. _____;

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