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AFFIDAVIT OF LOSS
I, JUDD DAVID, Filipino, of legal age, and a resident of San Rafael, Tarlac City, after
having been duly sworn to in accordance with law, do hereby depose and say:
2. That I lost said official receipt and despite diligent effort on my part to locate it, the
same could no longer be found;
3. That I now consider said official receipt lost and beyond recovery;
4. That I am executing this affidavit to inform the proper authority concerned about said
lost and for whatever legal purpose this affidavit may duly serve.
IN WITNESS whereof, I have hereunto set my hand this 17th day of April 2018 at
Tarlac City, Philippines.
JUDD DAVID
Affiant
SUBSCRIBED AND SWORN to before me this 17th day of April 2018 at Tarlac City,
Philippines, by Affiant who exhibited to me his Competent Evidence of Identity with details as
follows: