REPUBLIC OF THE PHILLIPINES)

IN THE CITY OF PAGADIAN…) S.S.

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AFFIDAVIT OF MANIFESTATION

I, JERLYN B. PALMA, of legal age, Filipino, and a resident of puork Sandayong, Sto. Niño District,
Pagadian City, Phillipines, after having been duly sworn to in accordance with law, hereby depose and
say;

That I am the holder/owner of Firearms described as follows to wit:

Kind: Pistol

Make: ARMSCOR

Caliber: 45

Serial No. 1152940

That the said Firearms should be tag or wanted to loss or it could be cancelled or deleted from
the record;

That I am executing this affidavit to attest to the truth of the foregoing allegations

IN WITNESS WHEREOF, I have hereunto affixed my signature this 23rd day of July 2019, at
Pagadian City, Phillipines.

JERLYN B. PALMA
Affiant

SUBSCRIBED AND SWORN to before me this 23rd day of July 2019, at Pagadian City, Phillipines

WITNESS MY HAND AND SEAL.

PAGE No.________
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Series of 2019