Republic of the Philippines )

City of Butuan ) S.S.

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AFFIDAVIT OF GUADIANSHIP

I, DINA H. SUPERALES, Filipino, of legal age, married and a resident of Brgy.

Bonbon, Butuan City, having been duly sworn in accordance with law, hereby
depose and state THAT:

1. I am the biological mother of minor RENCE RODINE H. SUPERALES;

2. He is presently under my care and custody;

3. I am not an imbecile, insane, a vagrant or a vicious person or a habitual

drunkard or a habitual criminal, and have not abandon, neglected or
refused to support said minor or caused him to commit offenses against
the law; and

4. I am executing this Affidavit to attest to the truth of the foregoing facts and
for whatever legal purpose that this Affidavit may serve.

FURTHER AFFIANTS SAYETH NONE.

IN WITNESS WHEREOF, I have set my hand this 11th day of October 2023 at
Butuan City, Philippines.

DINA H. SUPERALES
Affiant

Witnesses:

_________________________________ _________________________________

SUBSCRIBED AND SWORN to before me this 11 th day of October 2023 at Butuan

City, Philippines.

Doc. No. _____ ;

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