AFFIDAVIT OF DESISTANCE

REPUBLIC OF THE PHILIPPINES)

CITY OF MANILA
) S.S.
(the persons and circumstances below is fictional, please revise)
I, Juan del la Cruz, of legal age, single, and a resident of # 123
Main St., Malate, Manila, 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, Metropolitan Trial Court,
Branch No. 11, City of Manila.
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 Manila 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 Manila to dismiss with prejudice the said criminal case.
IN WITNESS WHEREOF, I hereby set my hand this __ day of
September 20__ at the City of Manila.

Juan de la Cruz
Complaining Witness

SUBSCRIBED AND SWORN to before me this 22nd day of January 20__

at the City of Manila, Philippines.

Romeo Abad
Public Prosecutor