REPUBLIC OF THE PHILIPPINES )

TARLAC CITY, TARLAC )S.S.

AFFIDAVIT OF
CLOSURE OF BUSINESS

I, RODOLFO MANABAT MENDOZA, of legal age, Filipino, widower and with

business address at Brgy. Alfonso Concepcion, Tarlac, after being duly sworn to in
accordance with law, do hereby depose and say:

1. That I am the widower of the late-LUCITA DAYRIT MENDOZA who died

on March 15, 2023 at The Medical City Clark, 100 Gatwick Gateway,
Sabah Al Ahmad, GGLC, Industrial Estate 5, Clark Freeport Zone,
Mabalacat City, Pampanga;

2. That my late wife is the registered owner of “VILLA LUCITA” located at

Brgy. Sto. Niñ o Concepcion, Tarlac, Region 3 (Central Luzon);

3. That the said business was issued a permit by the Department of Trade
and Industry (DTI) and Mayor’s permit issued by the Municipality of
Concepcion, Tarlac;

4. That however, the aforesaid business has ceased its operation since
March 15, 2023 due to the death of my late wife;

5. That I hereby attest that “VILLA LUCITA” has stopped operations since
March 15, 2023;

6. Submission of declaration under oath that the cancellation is not

intended to defraud creditors and that registered BN owner has no
understanding and pending financial obligation is connection with her
business.

7. That I am executing this affidavit to attest to the truthfulness of the

foregoing facts and circumstances.

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

______________________________ at Tarlac City, Tarlac, Philippines.

RODOLFO M. MENDOZA
Affiant

SUBSCRIBED AND SWORN TO BEFORE ME, on this date and place first above
written. Affiant exhibiting to me his Office of the Senior Citizens Affairs ID with No.
027059 issued at Concepcion, Tarlac on 12-02-15.

JOSELITO C. CASTRO
NOTARY PUBLIC
Doc No. ________; Until December 31, 2023
Page No. ________; Rollo No. 49046
Book No. ________; IBP No. 07355/1-07-08
Series of 2023. PTR No. 4488851/1-03-23
At Tarlac City, Tarlac