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REPUBLIC OF THE PHILIPPINES)

PROVINCE OF SURIGAO DEL SUR)


CITY OF TANDAG) S.s
x-------------------------------------------/

AFFIDAVIT
(Attesting to the Death of a Person)

That I, IRENEO L. BLASQUEZ, of legal age, Filipino, married to TERESITA LAPE-


BLASQUEZ, and a resident of Tacul, Magsaysay, Davao del Sur;

That I know the person of DAMIANA G. BLASQUEZ because she was my auntie, being
the sister of my father Ramon Blasquez;

That I know for fact that my auntie DAMIANA G. BLASQUEZ died on September 13,
1977 at Barangay Matho, Cortes, Surigao del Sur due to Natural death;

That the Office of Barangay Captain in Barangay Matho issued a Certification to support
such fact;

That I am executing this affidavit to attest to the truthfulness of the fact of death of the
person of DAMIANA G. BLASQUEZ and for whatever legal purposes that this statement may
serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 13th day of May, 2015, at
Tandag City, Surigao del Sur.

IRENEO L. BLASQUEZ
Affiant

SUBSCRIBED AND SWORN TO BEFORE ME this 13th day of May, at Tandag City, Surigao
del Sur, proved to me on the basis of satisfactory evidence to be the person who appeared before
me.

Doc. No. ATTY. JOSE P. ZAFRA IV, R.M.T.


Page No. Notary Public
Book No. for Tandag City, Surigao del Sur
Series of 2015 until December 15, 2015
ZAFRA LAW OFFICES
086 Osmea St., Purok Maganda,
Barangay Bag-ong Lungsod,
Tandag City, Surigao del Sur 830
Attorney Roll No. 62822-5/62014
IBP no. 968854/ 4-11-2014/Pasig City
PTR no. 5138663/5-19-2014/Tandag City
MCLE Compliance No. V-0006827
REPUBLIC OF THE PHILIPPINES)
PROVINCE OF SURIGAO DEL SUR)
CITY OF TANDAG) S.s
x-------------------------------------------/

AFFIDAVIT
(Attesting to the Death of a Person)

That I, IRENEO L. BLASQUEZ, of legal age, Filipino, married to TERESITA LAPE-


BLASQUEZ, and a resident of Tacul, Magsaysay, Davao del Sur;

That I know the person of RAMON BLASQUEZ because he was my father;

That I know for fact that my father RAMON BLASQUEZ died on July 10, 1985 at
Barangay Matho, Cortes, Surigao del Sur due to Natural death;

That the Office of Barangay Captain in Barangay Matho issued a Certification to support
such fact;

That I am executing this affidavit to attest to the truthfulness of the fact of death of the
person of RAMON BLASQUEZ and for whatever legal purposes that this statement may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 13th day of May, 2015, at
Tandag City, Surigao del Sur.

IRENEO L. BLASQUEZ
Affiant

SUBSCRIBED AND SWORN TO BEFORE ME this 13th day of May, at Tandag City, Surigao
del Sur, proved to me on the basis of satisfactory evidence to be the person who appeared before
me.

Doc. No. ATTY. JOSE P. ZAFRA IV, R.M.T.


Page No. Notary Public
Book No. for Tandag City, Surigao del Sur
Series of 2015 until December 15, 2015
ZAFRA LAW OFFICES
086 Osmea St., Purok Maganda,
Barangay Bag-ong Lungsod,
Tandag City, Surigao del Sur 830
Attorney Roll No. 62822-5/62014
IBP no. 968854/ 4-11-2014/Pasig City
PTR no. 5138663/5-19-2014/Tandag City
MCLE Compliance No. V-0006827