Republic of sworn to in accordance with law hereby depose and

the
Philippines) say:
In the City of
Pasay - - - - - 1. That sometime on March _____, 2010 I
)S.S. purchased one (1) unit of _________________ from
X--------- ____________________, copy of the Deed of Sale is
---------- hereto attached, which car/vehicle is more
X particularly described as follows:

AFFIDAVIT MAKE - - - - -
OF CHASSIS NO.
CHANGE
OF COLOR 2. That when I purchased the said
car/vehicle it was color white but it was very rusty
and needed to be repainted;
I,
3. That I decided to repaint said car/vehicle
RENATO C. from color white to silver;

DACLAN , 4. That said car/vehicle is not involved in

any vehicular accident and it is free from any liens
of legal age, and encumbrances of whatever nature and the
repainting is not for any unlawful purpose nor evade
Filipino, any crimes;

married and 5. That I am executing this affidavit to

attest to the truth and veracity of the foregoing facts
residing at and for whatever legal purpose or purposes this
affidavit may serve.
Blk. 5, Lot
IN WITNESS WHEREOF, I have hereunto
11-A Roma affixed our signature this ___day April , 2010 in
Pasay City.
Street,

Centrava

Village, Las RENATO C. DACLAN

Pinas City, Affiant

after having SUBSCRIBED AND SWORN to before me this

____ day of April, 2010 in Pasay City.
been duly

Doc. No. _____;

Page No. ____ ;
Book No. ____;
Series of 2010..