Republic of the Philippines )

Province of Isabela ) S. S.
City of Ilagan )
x--------------------------------x


AFFIDAVIT OF INDIGENCY
I, HERMINIA V. EDUBALAD, of legal age, Filipino, married and a resident of Brgy.
Lita, Maconacon, Isabela, after having been duly sworn to in accordance with law, hereby
depose and state;
1. That I am the wife of METUDIO D. EDUBALAD;
2. That my husband is unemployed because of his illness and old age;
3. That due to his unemployment and my inability to work because of my old age, we
have no source of income;
4. That due to the above-mentioned reasons, we belong to the lower strata of life.
Attached herein is a Certificate of Indigency issued by the Barangay Captain of Brgy.
Lita, Maconacon, Isabela;
5. That I am executing this affidavit to declare the truth of the foregoing facts.

IN WITNESS WHEREOF, I have hereunto set my hand this ______ day of ______,
2014 at __________, Isabela.




HERMINIA V. EDUBALAD
Affiant


SUBSCRIBED AND SWORN to before me this ____ day of ________, 2014 in
__________, Isabela.




Doc. No. ________
Page No. ________
Book No. ________
Series of 2014.