REPUBLIC OF THE PHILIPPINES )

PROVINCE OF NORTHERN SAMAR)S.S.

MUNICIPALITY OF CATARMAN )

JOINT AFFIDAVIT OF FUNERAL

We, TIRSO ALEJANDRO and EDUARDO P. CUSTORIO, both of legal age,

Filipino citizens and a resident of Brgy. Poblacion, lope de Vega, Northern Samar,
after having been duly sworn to in accordance to law, hereby depose and say:

1. That we personally know SEVERA TONOG CAPALES, daughter of Sps.

Helario Capales and Rosaura Tonog Capales , of Lope de Vega,
Northern Samar;

2. That Severa Tonog Capales a resident of Brgy. Poblacion, Lope de Vega,

Northern Samar, died on January 20, 1990 at the age of eighty (80);

3. That on January 29, 1990 at St. Isidore The Farmer Parish, Brgy.
Poblacion, Lope de Vega, Northern Samar the funeral blessing took
place;

4. That we personally know and witnessed the fact concerning that Fr.
TEMOTIO ESQUILLO administer the said funeral blessing;

5. That we are executing this affidavit for all legal intents and purposes
this may serve.

IN WITNESS WHEREOF, we have hereunto set our hands this 23th day of
May 2018 at Catarman, Northern Samar.

TIRSO ALEJANDRO EDUARDO P. CUSTORIO

Affiant Affiant

SUBSCRIBED and SWORN to before me this 23th day of May 2018 at

Catarman, Northern Samar.

Doc. No. _____________;

Page No. _____________;
Book No. _____________;
Series of 2018.