AFFIDAVIT

That I, ROLITO A. MINTAC, of legal age, Filipino, single and a

resident of #3337 HollyDale Drive, Los Angeles, California, U.S.A. 90039,
after having been duly sworn to in accordance with law hereby depose and
state:

That I am an immigrant in U.S.A. for more than seven (7) years who
is presently working as an Assistant Nurse in California, U.S.A.;

That I attest that I am single and not married to anyone;

That I am executing this affidavit to attest to all the above facts and
for whatever legal purposes it may serve.

IN WITNESS WHEREOF, I have hereunto signed this ______th day of

____________________, 2015 at
___________________________________.

ROLITO A. MINTAC
Affiant
ID No ______________
Isued on ___________
At _________________