Republic of the Philippines)

City of kabanklan ) S.S

X------------------------------X

AFFIDAVIT OF CONSENT

I, JEAN M. RAFOLS of legal age, filipino, widow, and a resident of

Balicotoc, Ilog, Negros Occidental, Philippines having duly sworn to in
accordance with law hereby depose and states;

1. That, I am the Grandmother the minor CLARE ANNE RAFOLS who was
born on December 23, 2007;
2. That, I am the legal guardian and in custody of the child for almost 5
years since the death of his father;
3. That, Presently the said minor is in the custody of his mother in the person
Gesusa Monticino currently residing at the United States of America;
4. That, his mother was subsequently married to James L. Cross, a US
Citizen and residing at the United States of America;
5. That, James L. Cross have manifested his intention to adopt the said child;
6. That, as a grandmother and legal Guardian of the said minor, I am giving
my consent and approval for the adoption of the minor CLARE ANNE
RAFOLS;
7. That, I execute this affidavit to attest to the truthfulness of the forgoing
declarations and for any other purpose that this affidavit may serve.

IN WITNESS WHEREOF, I hereunto affix my signature this 15th day

of October 2018 at Kabankalan City, Philippines.

JEAN M. RAFOLS
Affiant
Senior Citizen No. 3752

SUBSCRIBE AND SWORN to before me this 15th day of October

2018 at Kabankalan City, Philippines. Affiant exhibited to me her competent
evidence of identity indicated below her name and the same was executed by
her voluntarily and of her own free will.