Republic of the Philippines )

City of Tacloban ) SS

AFFIDAVIT OF LOSS

I, CLINT K. DEJARESCO, of legal age, Filipino, married and a resident of

Pob. Dist. III, La Paz, Leyte, after having been sworn to according to law, hereby
deposes and states ---THAT:

1. I was issued two (2) violation tickets by Land Transportation Office

(LTO).

2. The two (2) violation tickets bear Reference No. 000000016368146 for
being apprehended last August 06, 2019 and Reference No. 000000020185225 for
being apprehended last June 14, 2021.

3. I placed the two (2) violation tickets in a drawer at our house.

However, when I searched for them during the last week of May 2022, I could not
find them.

4. Despite diligent search and efforts to locate the said two (2) violation
tickets, I could not find the same such that I now believe that it is now lost beyond
recovery.

5. I am executing this affidavit to attest to the truth of the loss of said two
(2) violation tickets by Land Transportation Office (LTO) and for whatever legal
purpose this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 06 June 2022 in

Tacloban City.

CLINT K. DEJARESCO
TIN: 945-861-431
Affiant

SUBSCRIBED AND SWORN to before me this 06 June 2022 in Tacloban

City, affiant is personally known to me, who personally signed before me the
foregoing affidavit and acknowledged that he executed the same.

Doc. No. 073

Page No.063 ATTY. NILE APRIL PELLERO ROBIÑO
Book No. V Notary Public for Tacloban City, Leyte
Notarial Commission No. 2020-01-09 until June 30, 2022, per B.M. No. 3795
SERIES OF 2022 Roll of Attorney’s No. 65007
IBP Lifetime No. 017601; 06-07-17; Leyte Chapter
PTR No. 6222137; 01-03-22; Julita, Leyte
AVILA, DE VEYRA & ROBIÑO Law & Notarial Office
Cor. P. Burgos and Juan Luna Streets, Brgy. 30, Tacloban City