REPUBLIC OF THE PHILIPPINES)

Quezon City
) S. S.
AFFIDAVIT
I, SARDENICA CHAVEZ LLANA, of legal age, Filipino, and a
resident of 14E Sta. Lucia Street, Rosalia Compound, Tandang Sora,
Quezon City, after having been duly sworn to in accordance with law,
hereby depose and say that:
1.

I am the former wife of Enrique Morales who died sometime

September, 1958 due to Leukemia;

2.

Our marriage bore a daughter, Elizabeth Chavez Morales,

who was born on May 15, 1954 at Caloocan City, a copy of
her Birth Certificate is attached herewith;

3.

I am executing this affidavit to attest the truth of the

foregoing facts in connection with my daughters petition for
cancellation of her other Certificate of Live Birth.

IN WITNESS WHEREOF, I have hereunto affixed my signature

this ______day of ______________ at Quezon City, Philippines.

SARDENICA CHAVEZ LLANA

Affiant
CTC No. 00908203; 01-11-10;
Q.C.
SUBSCRIBED AND SWORN to before me this _____ day of
_________________ at Quezon City, Philippines.