Republic of the Philippines)

City of Butuan ) S.S.

AFFIDAVIT

I, RAUL LUSORATA TUQUIB, of legal age, Filipino, married, and a

resident of Barangay Doongan, Butuan City under oath, depose and state:
1. That I am the nephew of the late YOLANDA LOZORATA SALES,
who died last March 04, 2020 in Butuan Medical Center, Butuan City
due to Respiratory Failure 2‫ ﹾ‬to Community Acquired Pneumonia-High
Risk, Hypoxia;
2. That she does not have any legitimate or illegitimate children;
3. That her parents and siblings are already dead;
4. That I am the one processing her registration of death because I was there
on the moment that she died;
5. That I would like to request four (4) certified true copies of her death
certificate;
6. That I am executing this affidavit to attest to the veracity of the foregoing
for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 5 th day

of March 2020 at Butuan City, Philippines.

RAUL LUSORATA TUQUIB

Affiant
UMID: CRN- 0111-3401341-2

SUBSCRIBED AND SWORN TO BEFORE ME this 5 th day of March 2020

at Butuan City, Philippines.

Doc. No. ________;

Page No. ________;
Book No. _________;
Series of 2020