Republic of the Philippines . . . .

)
Province of ________ . . . . . . .) §
City of ________ . . . . . . . . . . . .)

AFFIDAVIT OF DENIAL

I, ____________________, of legal age, Filipino and a resident of

_________________, after having been duly sworn to in accordance with law, do
hereby depose and say:

1. That I am trying to secure RTC Clearance at _______;

2. That when I tried to secure said clearance, I learned that a certain

__________ who is unknown to me was charged for a multiple crimes
before ____________ docketed as CRIMINAL CASE NOS.
_________;

3. That as per records, the middle name of said person is XXXX while my
middle name is YYYYY;

4. That as per records said person is a resident of XXXXXX, Pangasinan

while I am a resident of Barangay YYYYYY;

5. That XXXXX and Richard XXXXXX pertains to TWO DISTINCT

AND SEPARATE PERSONS; and

6. I am executing this affidavit voluntarily without force, threat, or

intimidation caused upon me, to attest to the truth of all the foregoing,
and to use the same for all legal intents and purposes it may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this

_____________at _______________.

YYYYYYYYYYY
-Affiant-

SUBSCRIBED AND SWORN to before me this _____________at

_______________.