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Republic of the Philippines ) City of Iloilo ) S.S.


I, Anastasia Grey, of legal age, single, and a resident of # 123 Main St., Jaro, Iloilo City, after having duly sworn to in accordance with law hereby depose and state: 1. I am the complaining witness for Serious Physical Injuries against Jesus Santos in the case entitled "People of the Philippines versus Jesus Santos", Criminal Case No. 12345, Municipal Trial Court, Branch No. 11, City of Iloilo. 2. After my sober and soul searching assessment and analysis of the incident, I have realized that because I was not wearing my eyeglasses and it was dark, I can not point out, without a doubt the accused or any other person/s who inflicted harm against me. 3. Since I could not state with certainty and without doubt the liability of Jesus Santos, in fairness to him, I am permanently withdrawing my complaint against him. I clear him of whatever responsibility or liability to me. 4. I hereby inform the City Prosecutor of Iloilo that I am withdrawing my complaint for Serious Physical Injuries in Criminal Case No. 12345 entitled "People of the Philippines versus Jesus Santos", Metropolitan Trial Court, Branch No. 11, City of Manila. 5. I likewise request the Metropolitan Trial Court, Branch No. 11, City of Iloilo to dismiss with prejudice the said criminal case.

IN WITNESS WHEREOF, I hereby set my hand this 23rd day of January 2013.

Anastasia Grey Affiant

SUBSCRIBED AND SWORN to before me this 23rd day of January 2013 at the City of Iloilo, Philippines, affiant exhibiting to me her SSS ID No. 1254 issued on January 5, 2013 at Iloilo City. Witness my hand and notarial seal on the day, year and place first above-written.

ATTY. RAIZA MARTESANO Notary Public for Iloilo City Commision Serial No. ____ Until Dec. 31, ___ Roll of Attorney No. ____ PTR No. ___/issued at___ on______ IBP No. ____ issued at____/on_____

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