REPUBLIC OF THE PHILIPPINES)

MUNICIPALITY OF STA CRUZ ) SS.

AFFIDAVIT OF NON-OPERATION

I, MEDELYN DELOS CIENTOS DOMINICE, of legal age, married, Filipino

citizen, and presently residing at Poblacion, Sta. Cruz, Davao del Sur after having
been duly sworn to in accordance with law, do hereby depose and say:
1. That I am the proprietor of Delos Cientos Store with business address at Sta.
Cruz Public Market, Sta. Cruz, Davao del Sur;
2. That to date, the said business has not commenced operations due to lack of
manpower, that is, there is no person available who will attend to the business;
3. That the undersigned intends to commence operations in the future should the
circumstances permit; and
4. That I am executing this affidavit in order to attest to the truth of the foregoing
and for whatever legal purpose this may serve.
IN WITNESS WHEREOF, I have hereunto set my hand this ____ day of
________________, 2015 at ______________, Philippines.

MEDELYN

DELOS

CIENTOS

DOMINICE
Affiant

SUBSCRIBED AND SWORN to before me this ____ day of _______________,

2015 in _________, Philippines, affiant exhibiting to me her ID
No.____________________________ as her competent evidence of identity.
Doc No. : _____
Page No.: ______
Book No.: ______

Series of 2015.

Notary Public