Republic of the Philippines

Department of Justice
NATIONAL PROSECUTION SERVICE
OFFICE OF THE CITY PROSECUTOR
Iriga City

XXX

NPS Case Nos. XXX

Complainant,

For: Violation of RA 8282

-versus-

XXXX,
Respondent/s.

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

I, XXX, of legal age, resident of Magnolia St., San Juan, Iriga City, after having been
duly sworn in accordance with law, depose and state that:
1. I am a respondent in the above-stated case;
2. I caused the preparation of the counter-affidavit;
3. I have read the contents thereof and the facts stated therein are true and correct of my
personal knowledge and/or on the basis of copies of documents and records in my
possession.

Done this 27th day of October 2016 at Naga City, Philippines.

XXX
Affiant

SUBSCRIBED AND SWORN to before me this 27th day of October 2016 at Naga
City affiant exhibiting to me her ID __________________________.

Doc. No. ____ ;

Page No. ____ ;
Book No.____ ;
Series of 2016.