REPUBLIC OF THE PHILIPPINES )

PROVINCE OF TARLAC ) S.S.

MUNICIPALITY OF PANIQUI )

AFFIDAVIT OF GROSS SALES

FOR THE YEAR 2017

I, DANTE S. PALASIGUE, of legal age, Filipino and with resident address at Barangay
Poblacion Norte, Paniqui, Tarlac, after having been duly sworn to according to law hereby
depose and state:

1. That I am the owner/proprietor of “PALASIGUE UPHOLSTERY”, located at

Burgos St., Pob. Norte, Paniqui, Tarlac;

2. That my Gross Sales for the year 2017 is EIGHTY THOUSAND THREE
HUNDRED FIFTY NINE PESOS AND THIRTEEN CENTAVOS
(Php 80,359.13), Philippine Currency;

3. That I am executing this Affidavit of Gross Sales in order to attest to the truth
and veracity of the foregoing statement and for the purpose of securing my
Business / Mayor’s Permit for the year 2018.

FURTHER, AFFIANT SAYETH NAUGHT.

IN WITNESS WHEREOF, I have hereunto set my hand this 25 th day of January, 2018,
at Paniqui, Tarlac.

DANTE S. PALASIGUE
Affiant
CTC No. 28574210
Issued on January 25, 2018
Issued in Paniqui, Tarlac

SUBSCRIBED and SWORN to before me, in the Municipality of Paniqui, Province of

Tarlac, this 25th day of January, 2018, by Dante S. Palasigue, personally known to me and who in
person signed before me the foregoing Affidavit.

Doc. No. _______;

Page No. _______;
Book No._______;
Series of 2018