City of _________________ ) x-----------------------------------x AFFIDAVIT OF DESISTANCE I, ____________________________________________ of legal age, Filipino and a resident of _______________________________________________________, after having been duly sworn to an oath in accordance with law depose and say: 1. That I am the same person executing this affidavit; 2. That I am the complaining witness for ____________________________________ against ________________________________________ in the case entitled _____________________________________________, Criminal Case No. _________________, ___________ Trial Court, Branch No. _______________, _____________________________, _____________________________, Philippines; 3. That after my sober and soul searching assessment and analysis of the incident, I have realized that because (reason for desistance); 4. Since I could not state with certainty and without doubt the liability of _______________________________________ in fairness to him/her, I am permanently withdrawing my complaint against him/her. I clear him/her of whatever responsibility or liability to me. 5. I hereby inform the (Municipal/City/Provincial Prosecutor) that I am withdrawing my complaint for ______________________________ in Criminal Case No. _______________ entitled _____________________________, ________________ Trial Court, Branch No. _________________, __________________________________, Philippines. 6. That I likewise request the __________________________ Trial Court, Branch No. ____________________, _____________________________, to dismiss with prejudice the said criminal case. 7. That we are executing this affidavit to attest to the truth of the foregoing and for whatever lawful purpose that it may serve. IN WITNESS WHEREOF, I have hereunto set my hand this ______ day of __________________, 2016 at __________________________________________. _________________________ Affiant ID No. ___________________ Issued by: ________________ Issued on: _________________
SUBSCRIBED AND SWORN to before me this ____ day of ______________, 2016 at
_______________________________________. Doc No. _____________ Page No. ____________ Book No. ____________ Series of 2016.