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)s.s.
I, X, 59 years old, Filipino citizen, married and a resident of A, after having been
sworn in accordance with law, hereby depose and say:
2. That Y was in my care before her demise since she died single and without
issue;
That I execute this Affidavit freely and voluntarily to attest to the foregoing facts
and for whatever legal purpose this may serve.
IN WITNESS WHEREOF, I hereunto set my hand this 11th day of October 2017
at B, Philippines.
X
Affiant