REPUBLIC OF THE PHILIPPINES )

PROVINCE OF EASTERN SAMAR) SS

MUNICIPALITY OF BALANGIGA )

AFFIDAVIT OF BUSINESS CLOSURE

I, MRS. LINA L. EDER of legal age, married, Filipino, with residence and
postal address at Barangay Beta-og, Lawaan, Eastern Samar, after having been
duly sworn to in accordance with law, do hereby depose and say:
1. That I am the operator of a BOTIKA NG BARANGAY, (BnB), granted by
the Department of Health and located in Barangay Beta-og, Lawaan,
Eastern Samar;
2. That I have been issued a BUSINESS PERMIT by the Municipal
Government of Lawaan, Eastern Samar;
3. That on November 2013, I closed the said business due to damage
brought about by Super Typhoon Yolanda to the establishment including
medicines, receipts, sales book, financial records, RIS and SLTO,
attached hereto is a certification issued and signed by Municipal Mayor
of the Municipality of Lawaan, Eastern Samar;
4. That the BnB has no outstanding liability and obligation;
5. That I execute the foregoing instrument in order to attest the truth of the
above facts for all legal intents and purposes it may serve.
AFFIANT FURTHER SAYETH NAUGHT.

MRS. LINA L. EDER

Affiant
DSWD ID No. 082612001-5 369-00027

SUBSCRIBED AND SWORN to before me this 11th day of December, 2016

in Balangiga, E. Samar affiant having exhibited to me her Community Tax
Certificate No. 05601317 issued at Lawaan, E. Samar on September 18, 2016.

Doc. No. 266;

Page No. 55;
Book No. IV;
Series of 2016.