Sei sulla pagina 1di 2

Republic of the Philippines)

Province of Marinduque) S. S.
Municipality of Sylvia )


I, LITA FEDERER y GO, 40 years old, single, resident of Barangay 2, Sylvia, after
having been sworn to an oath in accordance with law, do hereby depose and say:

1. That I have no work and monthly income;

2. That I am submitting myself voluntarily to the Sylvia MPS pursuant to its

revitalized campaign against illegal drugs and in response to the call of the
President of the Republic of the Philippines, President Rodrigo Roa Duterte
and the Chief of the PNP PDG Ronald Dela Rosa, for all persons
engaged/involved in any illegal drug activity to STOP from said illegal activities;

3. That I have occasionally violated the provisions of R.A. 9165;

4. That I UNDERTAKE to STOP all my activities which violate said law and will
help and cooperate with the PNP to eradicate this drug menace in our
communities by giving vital information related thereto;

5. That I caused the Sylvia MPS to take pictures on me and record my personal

6. That the foregoing statements has been translated to me in Waray dialect

which I understand and speak;

7. That I am executing this Affidavit to attest the veracity and truthfulness of the
foregoing statements;

IN TRUTH WHEREOF, I have hereunto affixed my signature this 9th day of July
2016 at Sylvia MPS, Philippines.


We hereby attest that LITA G. FEDERER went to Sylvia MPS he confided to us
his intention to reform himself from being a drug user. He asked us to accompany him to
Sylvia MPS as witness/es that his act is free and voluntary. This was translated into
Waray-waray dialect.

________________________ _________________________
Witness Witness
SUBSCRIBED AND SWORN to before me this ___th day of July 2016 in Sylvia
MPS and I hereby certify that I personally examined the affiant and I am satisfied that that
she fully understand the contents of her affidavit and that she voluntarily executed the


Chief PAO Sylvia
Administering Officer

DOC NO: ______

PAGE NO: _______
BOOK NO: ______
Series of 2016