(Affidavit of Desistance Theft)

Republic of the Philippines)

Province of_________________) S.S.
City/Municipality of ____________)
x––––––––––––x

AFFIDAVIT OF DESISTANCE
I,__________, of legal ages, Filipino,(single / married / widow), and a resident of
____________, Philippines, after having been duly sworn in accordance with
law, hereby depose and say:

That I am the private complainant in the criminal case entitled “____________”;

for Theft docketed as____________before___________Trial Court, Branch
_____,__________City, Philippines;

That I found out that the said accused at the time of the incident was not in
his right mind and did not know that what he was doing was wrongful and
criminal considering that he was suffering from Schizophrenia, Paranoid
Type in acute exacerbation as certified to by Dr.____________of____________;

That the items taken by the accused, consisting

of____________and____________were immediately recovered from him and their
values had been voluntarily reimbursed by the relatives of the said Accused;

In view of the foregoing, I finally manifest that I now completely and

absolutely exonerate the accused__________from any liability in connection
with the above-mentioned criminal case and that I am no longer interested,
and I hereby desist, in prosecuting the said criminal case;

That I execute this Affidavit of Desistance so that the above-mentioned

criminal case be immediately dismissed and considered finally closed and
the bond posted by the herein accused be released to him;

As such, I am respectfully praying that the aforementioned case against the

Accused____________ be dismissed and finally closed.
IN WITNESS WHEREOF,I have hereunto set my hand
this____________at__________City, Philippines.

Affiant