Republic of the Philippines )

Iligan City ) S. S.

AFFIDAVIT OF DESISTANCE

WE, VILMA ALQUIZA and KRISTITA GARCIA, Filipinos, of legal ages, and
presently residing at (address), respectively, after having been duly sworn to an
oath in accordance with the law, do hereby depose and say:

That we are the complaining witnesses against SAMUEL L. AGAN-, the driver of
the Dumptruck bearing Plate No. SJN- 953 owned by the City Government of Iligan
for the death of my(relation- son/daughter), EDUARDO ALQUIZA and BENITO
GARCIA and damages to property incurred as a result of a vehicular accident which
occurred on July 4, 2016 at Lambagohon, San Roque, Iligan City.

That the death sustained and damage incurred was purely accidental in nature
and does not warrant criminal prosecution.

That I am not interested in prosecuting the aforementioned driver, either

civilly or criminally.

That this affidavit is executed by me of my own free will and volition for the
purpose of seeking dismissal or refraining from further prosecution whether
criminal or civilly, the aforementioned driver of the above-described vehicle and
hereby waived all present and future rights and pertaining to said incident.

That the foregoing statement have been duly read by me and/or read and
translated to me in Cebuano dialect which I speak and understand and which are
true to the best of my knowledge.

IN WITNESS WHEREOF, I have set my signature this___ day of _______

2016.

Affiant

Signed in the presence of:

_____________________ _______________________
 SUBSRIBED AND SWORN to before me, in the City of Iligan this ___ day of
______ 2016, the affiant exhibiting his _____________ issued by ___________
issued on ______________ issued at ______________.

Doc No. ____

Page No. ____
Book No. ____
Series of 20__.