Republic of the Philippines)

City of Butuan ...............) S.S.

x----------------------------x

AFFIDAVIT

I, JENETTE S. CONDEZA, of legal age, Filipino, married and a resident of P-

1, Brgy. Sumilihon, Butuan City, Philippines, after having been duly sworn to in
accordance with law, do hereby depose and state:

1. That I am the wife of the late HANZ ARCHIBALD DAPAR CONDEZA who
died on 17 October 2013 at the Northern Mindanao Medical Center, Capitol
Compound, Cagayan de Oro City, Misamis Oriental;

2. That the immediate, antecedent and underlying causes of his death were
from Multiple Organ Failure, Sepsis and Nosocomial Pneumonia, correspondingly;

3. That his body was embalmed by a licensed embalmer named DENNIS

BOLLOZOS of Bollozos Funeral Homes, Butuan City;

4. That he was buried five (5) days after his death on 22 October 2013 at
the Public Cemetery of Barangay Taguibo, Butuan City;

5. That his death certificate was not immediately registered with the Office
of the City Civil Registrar, Butuan City, due to financial constraints and post-
pregnancy health issues, I am unable to process the same; And,

6. That I am executing this Affidavit to show proof of the foregoing facts and
to support my application for the delayed registration of the death of my husband,
HANZ ARCHIBALD DAPAR CONDEZA with the Office of the City Civil Registrar,
Butuan City.

IN WITNESS WHEREOF, I have hereunto set my hand this 27th day of

November 2013 in Butuan City, Philippines.

JENETTE S. CONDEZA
Affiant

SUBSCRIBED AND SWORN to before me this 27th day of October 2013 in

Butuan City, Philippines. Affiant exhibited to me her ID No. TCH1-1035104-1998
issued by the Department of Education Division of Butuan City and Community Tax
Certificate No. 35648587 issued 01-03-2013 in Butuan City.

ATTY. EDWIN JON L. PIZARRO

ROLL № 54951
PTR № 0548469 | 01-02-2013 | BUTUAN CITY
Doc. No. _____; IBP № 878528 | 01-02-2013 | BUTUAN CITY
Page No. _____; UNTIL DECEMBER 31, 2013
Book No. _____;
Series of 2013.
Republic of the Philippines)
City of Butuan ...............) S.S.
x----------------------------x

AFFIDAVIT

I, MERCY BAUTISTA DIANE, of legal age, Filipino, widow and a resident of

P-1, Brgy. Ampayon, Butuan City, Philippines, after having been duly sworn to in
accordance with law, do hereby depose and state:

1. That I am the wife of the late LEON JR. CANSANCIO DIANE who died on
17 October 1999 at our own residence at Brgy. Taligaman, Butuan City;

2. That complications from tuberculosis caused his sudden death;

3. That the corpse of my husband was buried at the Public Cemetery of

Barangay Taligaman, Butuan City;

4. That his death certificate was not immediately registered with the Office
of the City Civil Registrar, Butuan City, due to financial constraints;

5. That I am processing his Death Certificate in order to comply with the

marriage requirements of our daughter; And,

6. That I am executing this Affidavit to attest the veracity of the foregoing

statements and for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 16th day of

December 2013 in Butuan City, Philippines.

MERCY BAUTISTA DIANE

Affiant

SUBSCRIBED AND SWORN to before me this 16th day of December 2013 in

Butuan City, Philippines. ________ ID No. _____________ issued on ___________
issued at _____________ and ___________ ID No. ________________ issued on
_____________ issued at _____________.

ATTY. EDWIN JON L. PIZARRO

ROLL № 54951
PTR № 0548469 | 01-02-2013 | BUTUAN CITY
IBP № 878528 | 01-02-2013 | BUTUAN CITY
Doc. No. _____; UNTIL DECEMBER 31, 2013
Page No. _____;
Book No. _____;
Series of 2013.
Republic of the Philippines)
City of Butuan ...............) S.S.
x----------------------------x

AFFIDAVIT

I, MENIROSA OLIVERIO PENASO, of legal age, Filipino, married and a

resident of P-2, Brgy. Pianing, Butuan City, Philippines, after having been duly
sworn to in accordance with law, do hereby depose and state:

1. That I know the facts and circumstances surrounding the death of the late
ALFREDO CUBILLAS HANOPOL being a relative by consanguinity and affinity;

2. That he died on 03 July 1970 at his own residence at P-2, Brgy. Pianing,
Butuan City due to complications from a serious lung illness;

3. That his death certificate was not immediately registered with the Office of
the City Civil Registrar, Butuan City, because of inadvertence and negligence of the
person delegated to do so;

4. That his body was not embalmed and was buried immediately at the public
cemetery at Taguibo, Butuan City;

5. That I am processing his Death Certificate with the Office of the City Civil
Registrar, Butuan City, to acquire his Taxpayer’s Identification Number from the
Bureau of Internal Revenue (BIR);

6. That I am executing this Affidavit to attest the truthfulness of the

foregoing statements and for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 20th day of

December 2013 in Butuan City, Philippines.

MENIROSA OLIVERIO PENASO

Affiant

SUBSCRIBED AND SWORN to before me this 20th day of December 2013 in

Butuan City, Philippines. Affiant exhibited her UMID ID No. 0111-1194135-8 and
PhilHealth ID No. 18-025153317-0.

ATTY. EDWIN JON L. PIZARRO

ROLL № 54951
PTR № 0548469 | 01-02-2013 | BUTUAN CITY
IBP № 878528 | 01-02-2013 | BUTUAN CITY
Doc. No. _____; UNTIL DECEMBER 31, 2013
Page No. _____;
Book No. _____;
Series of 2013.
Republic of the Philippines)
City of Butuan ...............) S.S.
x----------------------------x

AFFIDAVIT

I, RAYMUNDO SAANG DUNCANO, of legal age, Filipino, married and a

resident of P-1, Brgy. Ambago, Butuan City, Philippines, after having been duly
sworn to in accordance with law, do hereby depose and state:

1. That I am the natural and legitimate son of the late DOLORES SAANG
DUNCANO who died from stroke on 22 September 2001 at P-4, Brgy. Maug,
Butuan City;

2. That being her only son, I am the one who arranged her funeral;

3. That her death certificate was not immediately registered with the Office
of the City Civil Registrar, Butuan City, because of inadvertence and negligence of
the person delegated to do so;

4. That her body was embalmed and was interred in San Vicente Memorial
Park in Brgy. Bancasi, Butuan City;

5. That I am executing this Affidavit to attest the truthfulness of the

foregoing statements and for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 7th day of

January 2014 in Butuan City, Philippines.

RAYMUNDO SAANG DUNCANO

Affiant

SUBSCRIBED AND SWORN to before me this 7th day of January 2014 in

Butuan City, Philippines. Affiant exhibited his PhilHealth Identification Card No. 23-
001365100-6 and Barangay Tanod Identification Card No. BT004-06 issued by the
City Government of Butuan.

ATTY. ANNA LIZA L. GONZALES

NOTARY PUBLIC
COMMISSION VALID UNTIL DECEMBER 31, 2014
Doc. No. _____; ROLL № 39782
Page No. _____; PTR № 0706870 | 01-02-2014 | BUTUAN CITY
Book No. _____; IBP № 907786 | 01-02-2014 | BUTUAN CITY
Series of 2014.
Republic of the Philippines)
City of Butuan ...............) S.S.
x----------------------------x

AFFIDAVIT OF ATTENDANT AT DEATH

I, JOVITA MUTIA DALAGAN, of legal age, Filipino, married and a resident

of P-4, Brgy. Sangay, Buenavista, Agusan del Norte, Philippines, after having been
duly sworn to in accordance with law, do hereby depose and state:

1. That I am the natural and legitimate daughter of the late CATALINO

BALDE MUTIA who died on 12 December 2013 at Manuel J. Santos Hospital,
Montilla Boulevard, Butuan City;

2. That the immediate, antecedent and underlying causes of his sudden

death were from Intestinal Obstruction secondary to Distal Colonic Mass, Prob.
Colonic Ca with Peritoneal Seedings S/P and Coronary Heart Disease, Hypovolemic
Shock, Cardiorespiratory Arrest, correspondingly;

3. That his body was embalmed by a duly licensed embalmer named ROMEL
B. BENIG of St. Peter Memorial Chapel, Butuan City, with license # 09-13-5200
issued on 09-19-2013 at the City of Manila valid until 01-26-2016;

4. That he was buried four (4) days after his death on 16 December 2013 at
the Public Cemetery of Barangay Sangay, Buenavista, Agusan del Norte;

5. That his death certificate was not immediately registered with the Office
of the City Civil Registrar, Butuan City, because of some unavoidable circumstances
and financial constraints; And,

6. That I am executing this Affidavit to attest the truthfulness of the

aforementioned statements and to support my application for the delayed death
registration of my father, CATALINO BALDE MUTIA with the Office of the City Civil
Registrar, Butuan City.

IN WITNESS WHEREOF, I have hereunto set my hand this 13th day of

January 2014 in Butuan City, Philippines.

JOVITA MUTIA DALAGAN

Affiant

SUBSCRIBED AND SWORN to before me this 13th day of January 2014 in

Butuan City, Philippines. Affiant exhibited to me her Unified Multipurpose
Identification (UMID) Card No. 006-0098-1240-0 and Employee Identification Card
No. P 070106-026 issued by the Municipal Government of Buenavista, Agusan del
Norte.

ATTY. ANNA LIZA L. GONZALES

NOTARY PUBLIC
COMMISSION VALID UNTIL DECEMBER 31, 2014
ROLL № 39782
Doc. №: ; PTR № 0706870 | 01-02-2014 | BUTUAN CITY
Page №: ; IBP № 907786 | 01-02-2014 | BUTUAN CITY
Book №: ; MCLE № IV 0013372 | 03-06-2013
Series of 2014. DOONGAN RD., BUTUAN CITY
Republic of the Philippines)
City of Butuan .................) S.S.
x----------------------------x

AFFIDAVIT OF ATTENDANT AT DEATH

I, VALERIANA M. SABALLA, of legal age, Filipino, widow and a resident of

P-21A, Brgy. Tungao, Butuan City, Philippines, after having been duly sworn to in
accordance with law, do hereby depose and state:

1. That I am the widow of the late PEDRO D. SABALLA who died at the age
of seventy-one (71) from hypertension on 03 December 2013 at our own residence
in P-21A, Brgy. Tungao, Butuan City;

2. That he was buried three (3) days after his death on 6 December 2013 at
the Danapa Cemetery in Brgy. Tungao, Butuan City;

3. That his death certificate was not immediately registered with the Office
of the City Civil Registrar, Butuan City, because of some unavoidable circumstances
and financial constraints; And,

4. That I am executing this Affidavit to attest the truthfulness of the

aforementioned statements and to support my application for the delayed death
registration of my husband, PEDRO D. SABALLA with the Office of the City Civil
Registrar, Butuan City.

IN WITNESS WHEREOF, I have hereunto set my hand this 27th day of

January 2014 in Butuan City, Philippines.

VALERIANA M. SABALLA
Affiant

SUBSCRIBED AND SWORN to before me this 27th day of January 2014 in

Butuan City, Philippines. Affiant exhibited to me her Senior Citizen’s Identification
Card No. 8600-6465 issued on 09-13-2010 at Butuan City and Community Tax
Certificate (CTC) No. 29693740 issued on 01-16-2014 at Brgy. Tungao, Butuan
City.

ATTY. ANNA LIZA L. GONZALES

NOTARY PUBLIC
COMMISSION VALID UNTIL DECEMBER 31, 2014
ROLL № 39782
Doc. №: ; PTR № 0706870 | 01-02-2014 | BUTUAN CITY
Page №: ; IBP № 907786 | 01-02-2014 | BUTUAN CITY
Book №: ; MCLE № IV 0013372 | 03-06-2013
Series of 2014. DOONGAN RD., BUTUAN CITY
Republic of the Philippines)
City of Butuan .................) S.S.
x----------------------------x

AFFIDAVIT OF ATTENDANT AT DEATH

I, ABUNDIO J. PANCHO, of legal age, Filipino, widower and a resident of P-

11A, Brgy. San Mateo, Butuan City, Philippines, after having been duly sworn to in
accordance with law, do hereby depose and state:

1. That I am the widower of the late GLORIA CAYUMO PANCHO who died
at dawn (04:00am) on 16 June 1997 at our own residence in P-11A, Brgy. San
Mateo, Butuan City;

2. That her body was not embalmed and was buried later in the afternoon of
the same date at the San Mateo Cemetery, P-11A, Brgy. San Mateo, Butuan City;

3. That her death certificate was not immediately registered with the Office
of the City Civil Registrar in Butuan City because of accessibility and financial
constraints and other unavoidable circumstances; And,

4. That I am executing this Affidavit to attest the truthfulness of the

foregoing facts of death and to support my application for the delayed registration
of the same with the Office of the City Civil Registrar, Butuan City.

IN WITNESS WHEREOF, I have hereunto set my hand this 6th day of

February 2014 in Butuan City, Philippines.

ABUNDIO J. PANCHO
Affiant

SUBSCRIBED AND SWORN to before me this 6th day of February 2014 in

Butuan City, Philippines. Affiant exhibited to me his Membership Identification Card
No. 08-0507074-3 issued by the Social Security System (SSS).

ATTY. ANNA LIZA L. GONZALES

NOTARY PUBLIC
COMMISSION VALID UNTIL DECEMBER 31, 2014
ROLL № 39782
PTR № 0706870 | 01-02-2014 | BUTUAN CITY
IBP № 907786 | 01-02-2014 | BUTUAN CITY
Doc. №: ; MCLE № IV 0013372 | 03-06-2013
Page №: ; DOONGAN RD., BUTUAN CITY
Book №: ;
Series of 2014.
Republic of the Philippines)
City of Butuan .................) S.S.
x----------------------------x

AFFIDAVIT OF ATTENDANT AT DEATH

I, CRISTOTO P. BANGA, of legal age, Filipino, widower and a resident of P9,

Brgy. Dulag, Butuan City, Philippines, after having been duly sworn to in
accordance with law, do hereby depose and state:

1. That I am the widower of the late JOVITA PAGUYA BANGA who died at
the age of thirty-one (31) from dengue hemorrhagic fever on 08 October 2013 at
the Agusan Provincial Hospital, Brgy. Libertad, Butuan City;

2. That she was buried on the afternoon of the following day (09 October
2013) at the Public Cemetery in P-2, Brgy. Dulag, Butuan City;

3. That her death certificate was not immediately registered with the Office
of the City Civil Registrar in Butuan City because I was busy attending to the needs
of my children;

4. That I am executing this Affidavit to attest the truthfulness of the

foregoing facts of death and to support my application for the delayed registration
of the same with the Office of the City Civil Registrar, Butuan City.

IN WITNESS WHEREOF, I have hereunto set my hand this 12th day of

February 2014 in Butuan City, Philippines.

CRISTOTO P. BANGA
Affiant

SUBSCRIBED AND SWORN to before me this 12th day of February 2014 in

Butuan City, Philippines. Affiant exhibited to me his Membership Identification Card
No. 08-1397003-9 issued by the Social Security System (SSS).

ATTY. ANNA LIZA L. GONZALES

NOTARY PUBLIC
COMMISSION VALID UNTIL DECEMBER 31, 2014
ROLL № 39782
PTR № 0706870 | 01-02-2014 | BUTUAN CITY
IBP № 907786 | 01-02-2014 | BUTUAN CITY
Doc. №: ; MCLE № IV 0013372 | 03-06-2013
Page №: ; DOONGAN RD., BUTUAN CITY
Book №: ;
Series of 2014.
Republic of the Philippines)
City of Butuan .................) S.S.
x----------------------------x

AFFIDAVIT OF ATTENDANT AT DEATH

I, FLAVIANA KWAN CASTAÑARES, of legal age, Filipino, widow and a

resident of P-7, Amamaylan, Brgy. Baan Km. 3, Butuan City, Philippines, after
having been duly sworn to in accordance with law, do hereby depose and state:

1. That I am the natural and legitimate mother of the late ANTONIO KUAN
CASTAÑARES who died on 26 December 2013 at the age of fifty-five (55) at the
Butuan Medical Center, Km. 5, Brgy. Baan, Butuan City;

2. That the immediate, antecedent and underlying causes of his

sudden/unexpected death were from cardiopulmonary arrest secondary to
craniocerebral injury and mauling, respectively;

3. That his body was embalmed by a licensed embalmer of Mata Funeral

Homes;

4. That his remains were interred at the Public Cemetery of Brgy. Taguibo,
Butuan City, four (4) days after his death on 31 December 2013;

5. That his death certificate was not immediately registered with the Office
of the City Civil Registrar in Butuan City because the person delegated to do so
failed due to some unavoidable circumstances, hence, this Affidavit;

6. That I am executing this Affidavit to attest the truthfulness of the

foregoing facts of death and to support my application for the delayed registration
of the same with the Office of the City Civil Registrar, Butuan City.

IN WITNESS WHEREOF, I have hereunto set my hand this 26th day of

February 2014 in Butuan City, Philippines.

FLAVIANA KWAN CASTAÑARES

Affiant

SUBSCRIBED AND SWORN to before me this 26th day of February 2014 in

Butuan City, Philippines.

ATTY. ANNA LIZA L. GONZALES

NOTARY PUBLIC
COMMISSION VALID UNTIL DECEMBER 31, 2014
ROLL № 39782
PTR № 0706870 | 01-02-2014 | BUTUAN CITY
Doc. №: ; IBP № 907786 | 01-02-2014 | BUTUAN CITY
Page №: ; MCLE № IV 0013372 | 03-06-2013
Book №: ; DOONGAN RD., BUTUAN CITY
Series of 2014.
Republic of the Philippines)
City of Butuan .................) S.S.
x----------------------------x

AFFIDAVIT OF ATTENDANT AT DEATH

I, MARK JAMES A. MARTINEZ, of legal age, Filipino and a resident of P-1,

Brgy. De Oro, Butuan City, Philippines, after having been duly sworn to in
accordance with law, do hereby depose and state:

1. That I am the natural and legitimate son of the late IBRAHIM ABADIEZ
MARTINEZ who died on 21 January 2014 at the age of fifty-six (56) at the Agusan
del Norte Provincial Hospital, Brgy. Libertad, Butuan City;

2. That the immediate, antecedent and underlying causes of his

sudden/unexpected death were from hypertension, severe, cerebral hemorrhage,
respectively;

3. That his body was not embalmed as it is prohibited/forbidden by Islamic

culture/tradition;

4. That his remains were interred in the afternoon of the same date of his
death at the Taligaman Islamic Cemetery, Butuan City;

5. That his death certificate was not immediately registered with the Office
of the City Civil Registrar in Butuan City because the person delegated to do so
failed due to some unavoidable circumstances, hence, this Affidavit;

6. That I am executing this Affidavit to attest the truthfulness of the

foregoing facts of death and to support my application for the delayed registration
of the same with the Office of the City Civil Registrar, Butuan City.

IN WITNESS WHEREOF, I have hereunto set my hand this 26th day of

February 2014 in Butuan City, Philippines.

MARK JAMES A. MARTINEZ

Affiant

SUBSCRIBED AND SWORN to before me this 26th day of February 2014 in

Butuan City, Philippines. Affiant exhibited to me his PhilHealth Identification Card
No. 18-050113464-1.

ATTY. ANNA LIZA L. GONZALES

NOTARY PUBLIC
COMMISSION VALID UNTIL DECEMBER 31, 2014
ROLL № 39782
Doc. №: ; PTR № 0706870 | 01-02-2014 | BUTUAN CITY
Page №: ; IBP № 907786 | 01-02-2014 | BUTUAN CITY
Book №: ; MCLE № IV 0013372 | 03-06-2013
Series of 2014. DOONGAN RD., BUTUAN CITY
Republic of the Philippines)
City of Butuan ...............) S.S.
x----------------------------x

AFFIDAVIT

I, MENIROSA OLIVERIO PENASO, of legal age, Filipino, married and

a resident of P-2, Brgy. Pianing, Butuan City, Philippines, after having been
duly sworn to in accordance with law, do hereby depose and state:

1. THAT I know the facts and circumstances surrounding the death of

the late FILOMENA LINGERAS HANOPOL being a relative by
consanguinity and affinity;

2. THAT she died from natural causes on 09 December 1975 at her

own residence in P-2, Brgy. Pianing, Butuan City;

3. THAT her death certificate was not immediately registered with the
Office of the City Civil Registrar, Butuan City, because of
inadvertence/negligence and failure of the person delegated to do so, hence,
this Affidavit;

4. THAT her body was not embalmed and was buried immediately at
the public cemetery at Brgy. Taguibo, Butuan City;

5. THAT the copy of her CRS Form No. 2 (Negative Certification of

Death) is herein attached to form an integral part of this Affidavit; And,

6. THAT I am executing this Affidavit to attest the truthfulness of the

foregoing statements and to support my transfer of her title/declaration to
my name with the Bureau of Internal Revenue (BIR) and other concerned
agencies/offices.

IN WITNESS WHEREOF, I have hereunto set my hand this 4th day of

March 2014 in Butuan City, Philippines.

MENIROSA OLIVERIO PENASO

Affiant

SUBSCRIBED AND SWORN to before me this 4th day of March 2014

in Butuan City, Philippines. Affiant exhibited her UMID ID No. 0111-
1194135-8 and PhilHealth ID No. 18-025153317-0.

ATTY. ANNA LIZA L. GONZALES

NOTARY PUBLIC
COMMISSION VALID UNTIL DECEMBER 31, 2014
ROLL № 39782
Doc. №:________________; PTR № 0706870 | 01-02-2014 | BUTUAN CITY
Page №:________________; IBP № 907786 | 01-02-2014 | BUTUAN CITY
Book №:________________; MCLE № IV 0013372 | 03-06-2013
Series of 2014. DOONGAN RD., BUTUAN CITY
Republic of the Philippines)
City of Butuan .................) S.S.
x----------------------------x

AFFIDAVIT OF ATTENDANT AT DEATH

I, CRESENCIA T. TAGHOY, of legal age, Filipino, widow and a resident of P-

4, Brgy. San Mateo, Butuan City, Philippines, after having been duly sworn to in
accordance with law, do hereby depose and state:

1. That I am the widow of the late BERNARDO ENCARQUEZ TAGHOY SR.,

who died suddenly/unexpectedly at the age of seventy-one (71) on 01 December
2013 at our own residence in P-4, Brgy. San Mateo, Butuan City,

2. That his body was not embalmed and was buried/interred at the Public
Cemetery of Brgy. San Mateo, Butuan City, on the afternoon of the following day
(02 December 2013);

3. That I failed to register his death certificate with the Office of the City
Civil Registrar in Butuan City primarily because of health reasons and because of
my children’s refusal, hence, this Affidavit;

4. That attached herewith is the Certification issued by the Hon. Edgardo L.

Eduava, Punong Barangay, to form an integral part of this Affidavit; And,

5. That I am executing this Affidavit to attest the truthfulness of the

foregoing facts of death and to support my application for the delayed registration
of the same with the Office of the City Civil Registrar, Butuan City.

IN WITNESS WHEREOF, I have hereunto set my hand this 18th day of

March 2014 in Butuan City, Philippines.

CRESENCIA T. TAGHOY
Affiant

SUBSCRIBED AND SWORN to before me this 18th day of March 2014 in

Butuan City, Philippines. Affiant appeared before me, exhibited to me her
Community Tax Certificate (CTC) No. 29731359 issued on 03-18-2014 at Butuan
City, and Senior Citizen’s Identification Card No. 8600-2928 issued on 10-21-2008
by the Office for Senior Citizens Affairs (OSCA), Butuan City, and is personally
known to me.

ATTY. EDWIN JON L. PIZARRO

ROLL № 54951
Doc. №: ; PTR № 0712952 | 01-02-2014 | BUTUAN CITY
Page №: ; IBP № 907785 | 01-02-2014 | BUTUAN CITY
Book №: ; MCLE № IV 0012897 | 02-27-2013
Series of 2014. UNTIL DECEMBER 31, 2015
Republic of the Philippines)
City of Butuan .................) S.S.
x----------------------------x

AFFIDAVIT OF ATTENDANT AT DEATH

I, MELCA C. QUINABANDAL, of legal age, single, Filipino and a resident of

Purok 1, Brgy. Manila de Bugabus, Butuan City, Philippines, after having been duly
sworn to in accordance with law, do hereby depose and state:

1. That I am the natural and legitimate daughter of the late SALUD

CORMANES QUINABANDAL who died from complications of bone cancer at the
age of sixty-two (62) on 01 January 2014 at her own residence in Purok 9 Upper
Sdaon, Brgy. Sumile, Butuan City;

2. That her body was not embalmed and was buried/interred at the Public
Cemetery of Brgy. Sumile, Butuan City, on the afternoon of the same date of her
death;

3. That I failed to register her death certificate with the Office of the City Civil
Registrar in Butuan City primarily because of inadvertence/negligence and other
unavoidable circumstances, hence, this Affidavit;

4. That I am executing this Affidavit to attest the truthfulness of the

foregoing facts of death and to support my application for the delayed registration
of the same with the Office of the City Civil Registrar, Butuan City.

IN WITNESS WHEREOF, I have hereunto set my hand this 1st day of April
2014 in Butuan City, Philippines.

MELCA C. QUINABANDAL
Affiant

SUBSCRIBED AND SWORN to before me this 1st day of April 2014 in

Butuan City, Philippines. Affiant appeared before me, exhibited to me her
Community Tax Certificate (CTC) No. 29726049 issued on 03-24-2014 at Butuan
City, and is personally known to me.

ATTY. EDWIN JON L. PIZARRO

ROLL № 54951
PTR № 0712952 | 01-02-2014 | BUTUAN CITY
IBP № 907785 | 01-02-2014 | BUTUAN CITY
Doc. №: ; MCLE № IV 0012897 | 02-27-2013
UNTIL DECEMBER 31, 2015
Page №: ;
Book №: ;
Series of 2014.
Republic of the Philippines)
City of Butuan .................) S.S.
x----------------------------x

AFFIDAVIT OF ATTENDANT AT DEATH

I, MARCELINO P. SALUDO of legal age, widower, Filipino and a resident of

Purok 18, Brgy. Manila de Bugabus, Butuan City, Philippines, after having been duly
sworn to in accordance with law, do hereby depose and state:

1. That I am the widower of the late PAULINA NANAT SALUDO who died
aged sixty-one (61) from natural causes (old age) on 06 June 1999 at our own
residence at Purok 18, Brgy. Manila de Bugabus, Butuan City;

2. That her body was not embalmed and was buried/interred at the Public
Cemetery of Brgy. Manila de Bugabus, Butuan City, at around ten o’clock in the
morning of the following day;

3. That I failed to register her death certificate with the Office of the City Civil
Registrar in Butuan City primarily because of inadvertence, constraints concerning
money and accessibility and other circumstances, hence, this Affidavit;

4. That I am executing this Affidavit to attest the truthfulness of the

foregoing facts of death and to support my application for the delayed registration
of the same with the Office of the City Civil Registrar, Butuan City.

IN WITNESS WHEREOF, I have hereunto set my hand this 22nd day of April
2014 in Butuan City, Philippines.

MARCELINO P. SALUDO
Affiant

SUBSCRIBED AND SWORN to before me this 22nd day of April 2014 in

Butuan City, Philippines. Affiant appeared before me, exhibited to me his PhilHealth
Identification Card No. 2300-1371-0851 and Police Clearance No. 068180 issued on
04-21-2014 by the Butuan City Police Office, and is personally known to me.

ATTY. EDWIN JON L. PIZARRO

ROLL № 54951
Doc. №: ; PTR № 0712952 | 01-02-2014 | BUTUAN CITY
Page №: ; IBP № 907785 | 01-02-2014 | BUTUAN CITY
Book №: ; MCLE № IV 0012897 | 02-27-2013
Series of 2014. UNTIL DECEMBER 31, 2015
Republic of the Philippines)
City of Butuan .................) S.S.
x----------------------------x

AFFIDAVIT OF ATTENDANT AT DEATH

I, SANDER HINDENES of legal age, single, Norwegian and a resident of

795 Hindenesvegen, Ostereidet, Norway, after having been duly sworn to in
accordance with law, do hereby depose and state:

1. That I am the biological father of the child named MIGUEL GAITANO

HINDENES who died a day after his birth on 18 February 2014 at the Manuel J.
Santos Hospital, Montilla Boulevard, Butuan City;

2. That his body was not embalmed and was buried/interred at the UCCP
Cemetery, Brgy. 2, Buenavista, Agusan del Norte, on the same date of his death;

3. That I failed to register his death certificate with the Office of the City Civil
Registrar in Butuan City primarily because of inadvertence and other circumstances,
hence, this Affidavit;

4. That I am executing this Affidavit to attest the truthfulness of the

foregoing facts of death and to support my application for the delayed registration
of the same with the Office of the City Civil Registrar, Butuan City.

IN WITNESS WHEREOF, I have hereunto set my hand this 23rd day of April
2014 in Butuan City, Philippines.

SANDER HINDENES
Affiant

SUBSCRIBED AND SWORN to before me this 23rd day of April 2014 in

Butuan City, Philippines. Affiant appeared before me, exhibited to me his
Norwegian Passport No. 30029419 issued on 01-06-2014 valid until 01-06-2024
and is personally known to me.

ATTY. EDWIN JON L. PIZARRO

ROLL № 54951
PTR № 0712952 | 01-02-2014 | BUTUAN CITY
Doc. №: ; IBP № 907785 | 01-02-2014 | BUTUAN CITY
Page №: ; MCLE № IV 0012897 | 02-27-2013
Book №: ; UNTIL DECEMBER 31, 2015
Series of 2014.
Republic of the Philippines)
City of Butuan .................) S.S.
x----------------------------x

AFFIDAVIT OF ATTENDANT AT DEATH

I, MYRRH ARIANE YAPAC GAITANO of legal age, single, Filipino and a

resident of Purok 4, Brgy. 2, Buenavista, Agusan del Norte, Philippines, after having
been duly sworn to in accordance with law, do hereby depose and state:

1. That I am the biological mother of the child named MIGUEL GAITANO

HINDENES who died a day after his birth on 18 February 2014 at the Manuel J.
Santos Hospital, Montilla Boulevard, Butuan City;

2. That his body was not embalmed and was buried/interred at the UCCP
Cemetery, Brgy. 2, Buenavista, Agusan del Norte, on the same date of his death;

3. That I failed to register his death certificate with the Office of the City Civil
Registrar in Butuan City primarily because of inadvertence and other circumstances,
hence, this Affidavit;

4. That I am executing this Affidavit to attest the truthfulness of the

foregoing facts of death and to support my application for the delayed registration
of the same with the Office of the City Civil Registrar, Butuan City.

IN WITNESS WHEREOF, I have hereunto set my hand this 5th day of May
2014 in Butuan City, Philippines.

MYRRH ARIANE YAPAC GAITANO

Affiant

SUBSCRIBED AND SWORN to before me this 5th day of May 2014 in

Butuan City, Philippines. Affiant appeared before me, exhibited to me her Philippine
Passport No. EB5904086 issued on 07-11-2012 by the Department of Foreign
Affairs Regional Consular Office, Cagayan de Oro City, valid until 07-10-2017, and
is personally known to me.

ATTY. EDWIN JON L. PIZARRO

Doc. №: ; ROLL № 54951
Page №: ; PTR № 0712952 | 01-02-2014 | BUTUAN CITY
Book №: ; IBP № 907785 | 01-02-2014 | BUTUAN CITY
Series of 2014. MCLE № IV 0012897 | 02-27-2013
UNTIL DECEMBER 31, 2015
Republic of the Philippines)
City of Butuan .................) S.S.
x----------------------------x

AFFIDAVIT OF ATTENDANT AT DEATH

I, MERLINA B. ARAÑEZ of legal age, widow, Filipino and a resident of Purok

2, Brgy. San Mateo, Butuan City, Philippines, after having been duly sworn to in
accordance with law, do hereby depose and state:

1. That I am the widow of the late JOSE LIBRE ARAÑEZ who died aged
fifty-three (53) on 10 June 2008 at our own residence at Purok 2, Brgy. San Mateo,
Butuan City;

2. That his body was not embalmed and was buried/interred at the Public
Cemetery of Brgy. San Mateo, Butuan City, at around ten o’clock in the morning of
the following day;

3. That I failed to register his death certificate with the Office of the City Civil
Registrar in Butuan City primarily because of inadvertence, constraints concerning
money and accessibility and other circumstances, hence, this Affidavit;

4. That I am executing this Affidavit to attest the truthfulness of the

foregoing facts of death and to support my application for the delayed registration
of the same with the Office of the City Civil Registrar, Butuan City.

IN WITNESS WHEREOF, I have hereunto set my hand this 16th day of May
2014 in Butuan City, Philippines.

MERLINA B. ARAÑEZ
Affiant

SUBSCRIBED AND SWORN to before me this 16th day of May 2014 in

Butuan City, Philippines. Affiant appeared before me, exhibited to me her Police
Clearance No. 068852 and Community Tax Certificate (CTC) No. 29748294, both
issued on 04-29-2014 at Butuan City and is personally known to me.

ATTY. EDWIN JON L. PIZARRO

ROLL № 54951
Doc. №: ; PTR № 0712952 | 01-02-2014 | BUTUAN CITY
Page №: ; IBP № 907785 | 01-02-2014 | BUTUAN CITY
Book №: ; MCLE № IV 0012897 | 02-27-2013
Series of 2014. UNTIL DECEMBER 31, 2015
Republic of the Philippines)
City of Butuan .................) S.S.
x----------------------------x

AFFIDAVIT OF ATTENDANT AT DEATH

I, JANETH D. MORADO of legal age, single, Filipino and a resident of Purok

4, Brgy. 19 Buhangin, Butuan City, Philippines, after having been duly sworn to in
accordance with law, do hereby depose and state:

1. That I am the biological mother of the child named EUNICE MORADO

CURALDE who died at the time of her delivery on 27 March 2014 at the Agusan del
Norte Provincial Hospital, Brgy. Libertad, Butuan City;

2. That the cause of fetal death was due to the stillborn condition of the said
child;

3. That her body was not embalmed and was buried/interred at the Libertad
Public Cemetery, Brgy. Libertad, Butuan City, at 01:00 in the afternoon of the
following day (28 March);

4. That I failed to register her death certificate with the Office of the City Civil
Registrar in Butuan City primarily because of financial constraints and difficulty
coping up with my child’s death;

5. That I am executing this Affidavit to attest the truthfulness of the

foregoing facts of death and to support my application for the delayed registration
of the same with the Office of the City Civil Registrar, Butuan City.

IN WITNESS WHEREOF, I have hereunto set my hand this 8 December

2019 in Butuan City, Philippines.

JANETH D. MORADO
Affiant

SUBSCRIBED AND SWORN to before me this 8 December 2019 in Butuan

City, Philippines. Affiant appeared before me, exhibited to me her Taxpayer’s
Identification Card No. 945-111-725 issued on 04-03-2007 by the Bureau of
Internal Revenue (BIR) Revenue District Office No. 103, Butuan City, and is
personally known to me.

ATTY. EDWIN JON L. PIZARRO

ROLL № 54951
PTR № 0712952 | 01-02-2014 | BUTUAN CITY
Doc. №:________________; IBP № 907785 | 01-02-2014 | BUTUAN CITY
Page №:________________; MCLE № IV 0012897 | 02-27-2013
Book №:________________; UNTIL DECEMBER 31, 2015
Series of 2014.
Republic of the Philippines)
City of Butuan .................) S.S.
x----------------------------x

AFFIDAVIT OF ATTENDANT AT DEATH

I, MARIBETH B. GODIN of legal age, married, Filipino and a resident of

Purok 1C, Brgy. Ampayon, Butuan City, Philippines, after having been duly sworn to
in accordance with law, do hereby depose and state:

1. That I am the natural and legitimate daughter of the late EPIFANIA

SAGUISA BAGAIPO who died at the age of sixty-five (65) on 15 October 2012 at
the Butuan Medical Center, Km. 5, Brgy. Baan, Butuan City;

2. That the immediate and antecedent causes of her death were from
ruptured cerebral aneurysm, subarachnoid hemorrhage, intraventricular
hemorrhage and hydrocephalus, respectively;

3. That her body was embalmed by Arturo Mata Cinco, a licensed embalmer
of Mata Funeral Home in Brgy. Ampayon, and was buried nine (9) days later on 24
October 2012 at the Taguibo Public Cemetery, Brgy. Taguibo, Butuan City;

4. That because of financial constraints and other circumstances, I failed to

register her death certificate with the Office of the City Civil Registrar in Butuan
City;

5. That I am executing this Affidavit to attest the truthfulness of the

foregoing facts of death and to support my application for the delayed registration
of the same with the Office of the City Civil Registrar, Butuan City.

IN WITNESS WHEREOF, I have hereunto set my hand this 8 December

2019 in Butuan City, Philippines.

MARIBETH B. GODIN
Affiant

SUBSCRIBED AND SWORN to before me this 8 December 2019 in Butuan

City, Philippines. Affiant appeared before me, exhibited to me her 4P’s Modified
Conditional Cash Transfer Identification Card No. 160202007-0056645 and is
personally known to me.

ATTY. EDWIN JON L. PIZARRO

Doc. №:________________;
Page №:________________;
Book №:________________;
Series of 2014.
ROLL № 54951
PTR № 0712952 | 01-02-2014 | BUTUAN CITY
IBP № 907785 | 01-02-2014 | BUTUAN CITY
MCLE № IV 0012897 | 02-27-2013
UNTIL DECEMBER 31, 2015
Republic of the Philippines)
City of Butuan .................) S.S.
x----------------------------x

AFFIDAVIT OF ATTENDANT AT DEATH

I, LEILA PAGUMPANA SABALLA of legal age, married, Filipino and a

resident of Purok 9, Brgy. Dulag, Butuan City, Philippines, after having been duly
sworn to in accordance with law, do hereby depose and state:

1. That I am the natural and legitimate daughter of the late BERTOLDO

SALALIMA PAGUMPANA who was shot by three gunmen and died from gunshot
wounds at the age of forty-four (44) on 24 July 1981 at the Purok 9, Brgy. Dulag,
Butuan City;

2. That his body was not embalmed and was buried/interred on the afternoon
of the following day at the Bitan-agan Public Cemetery, Brgy. Bitan-agan, Butuan
City;

3. That we failed to register his death certificate with the Office of the City
Civil Registrar, Butuan City, primarily because it was difficult for us to cope up with
his death and that civil registration at that time was not yet obligatory, which
resulted into our inadvertence/negligence and our mother died on 26 October 2009;

4. That I am executing this Affidavit to attest the truthfulness of the

foregoing facts of death and to support my application for the delayed registration
of the same with the Office of the City Civil Registrar, Butuan City.

IN WITNESS WHEREOF, I have hereunto set my hand this 8 December

2019 in Butuan City, Philippines.

LEILA PAGUMPANA SABALLA

Affiant

SUBSCRIBED AND SWORN to before me this 8 December 2019 in Butuan

City, Philippines. Affiant appeared before me, exhibited to me her Taxpayer’s
Identification Card No. 455-085-778 issued on 07-21-2014 by the Bureau of
Internal Revenue (BIR) and is personally known to me.

ATTY. EDWIN JON L. PIZARRO

ROLL № 54951
Doc. №:________________; PTR № 0712952 | 01-02-2014 | BUTUAN CITY
Page №:________________; IBP № 907785 | 01-02-2014 | BUTUAN CITY
Book №:________________; MCLE № IV 0012897 | 02-27-2013
UNTIL DECEMBER 31, 2015
Series of 2014.