Republic of the Philippines )

MUNICIPALITY OF SAN PEDRO S.S

Province of Laguna
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AFFIDAVIT OF ABANDONMENT

I, MARY GRACE S. LAUS, of legal age, single, Filipino and with residential and post
office address at 1150 San Vicente, San Pedro Laguna, Philippines, after having been duly sworn
to in accordance with law, hereby depose and say;

1. That, I am the biological mother of MARIELLE S. LAUS born on July 16, 1998;

2. That, the biological father is ARESTOTLE P. LAUS;

3. That, since January 2002 up to present their father ARESTOTLE P. LAUS never heard
and seen again;

4. That I am executing this affidavit in order to attest to the truth of the foregoing
statements, to inform the authorities concerned and for all legal intents and purposes this
may serve best;

IN WITNESS WHEREOF, I have hereunto set my hand and affix my signature

below, this 31st day of October, 2013 at the Municipality of San Pedro Laguna.

MARY GRACE S. LAUS

Affiant

__________________________WITNESSS_______________________________

SUBSCRIBED AND SWORN to before me this 31st day of October, 2013 in San Pedro
Laguna. Affiant having exhibited to me her proof of Identity SSS ID No.33-1259161-5.

Doc. No: ________

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Book No.:________
Series of 2013