Form No.

2--Affidavit Attesting to the Death of a Person

(Affidavit Attesting to the Death of a Person)

REPUBLIC OF THE PHILIPPINES)

Province of ____________________) S.S.
City/Municipality of _____________)x - - - - - - - - - - - - - - - - - - - - -x

JOINT AFFIDAVIT

We, _____________ and _____________, both of legal ages, Filipinos,

and residents of _____________ and _____________, respectively, after having
been duly sworn to in accordance with law, do hereby depose and state the
following:

That we are Barangay Officials of the aforementioned Barangay being the

_____________ and _____________, respectively.

That we know the person of _____________ because he was a resident of the

aforementioned Barangay of which we are officials;

That we know for a fact the said _____________ died on _____________ at

_____________ due to _____________;

That we are executing this affidavit to attest to the truthfulness of the fact of
death of the person of _____________ and for whatever legal purposes that this
statement may serve.

IN WITNESS WHEREOF, we have hereunto set our hands this

_____________, in the City of _____________, Philippines.

AFFIANT AFFIANT

(JURAT)