REPUBLIC OF THE PHILIPPINES)
MUNICIPALITY OF MABINI) S.S.
AFFIDAVIT OF KINSHIP
I,HARRYJILL E. VALES, of legal age, Filipino Citizen and a resident of
Calzada, Mabini, Pangasinan, after having been sworn to in accordance
with law, do hereby depose and state that:
1. I am the nephew of the late MONICO M. BAGOS who died sometime in
December 11, 2020;
2. MONICO M. BAGOS died single and leaving no ascendants and
descendants;
3. I am the nearest surviving kin and relative of my deceased uncle;
4. I am executing this affidavit for purpose of requesting a copy of
Certificate of Death of MONICO M. BAGOS before the Muncipal Civil
Registrar of Mabini, Pangasinan;
5. Finally, I am executing this affidavit to attest to the truthfulness of the
foregoing declarations and for all legal intents and purposes this may
serve.
IN WITNESS WHEREOF, I have hereunto affix my signature this
___________ at Mabini, Pangasinan.
HARRYJILL E. VALES
Affiant
PHILHEALTH ID no. 01-051326361-4
SUBSCRIBED AND SWORN TO before me in the Municipality of
Mabini, this ___________. The affiant, who is known to me to be the same
person and voluntarily signed the foregoing document in my presence and
avow under penalty of law to the whole truth of the contents of the same.
WITNESS MY HAND AND SEAL.
Doc. No. _____
Page No. _____
Book No. _____
Series of 2024.
