Republic of the Philippines)

City of Tangub) S.S

x----------------------------------------x

SWORN DECLARATION OF GROSS

RECEIPTS/SALES

I, PAQUITA CASTILLANO, of legal age, Filipino, and a resident of Brgy.

Labuyo, Tangub City, after having been duly sworn in accordance with law
hereby depose and state:

1. That I am the registered owner of MELAI EATERY with

business address located at Barangay Labuyo, Tangub
City;

2. That during the first quarter of 2020 (January, February and

March), the gross receipts of my business amounted to
Twenty Five Thousand Pesos (PhP 25,000.00);

3. That I duly execute this SWORN DECLARATION in

compliance with the requirement of Local Government of
Tangub for the closure of the aforementioned business;

4. That I declare, under the penalties of perjury, that this

declaration has been made in good faith, and to the best of
my knowledge and belief to be true and correct.

IN WITNESS WHEREOF, I have hereunto set my hand this 8th day of

March 2021 at Tangub City, Philippines

JENNIFER CASTILLANO
Affiant
SSS: ____________

SUBSCRIBED AND SWORN to before me this 8th day of March

2021 in the City of Tangub, Philippines.

Doc. No. __________

Page No. __________
Book No. __________
Series of __________