REPUBLIC OF THE PHILIPPINES )

PROVINCE OF BATANGAS ) S. S.
CITY OF TANAUAN )

AFFIDAVIT OF NON-FILING OF
INCOME TAX/NON-EMPLOYMENT
I, SOFRONIO C. MEDALLA, 57 years old, married and resident of Brgy. Sta.
Anastacia, Municipality of Sto. Tomas, Batangas, after having been sworn to in
accordance with law, hereby depose and say, THAT:

1. I am married to Cristina C. Medalla and because of our union we have four

(4) children, one of whom is Angelo C. Medalla who is an applicant of scholarship with
Batangas State University located in Malvar, Batangas;

2. One of the requirement for the same is the submission of Income Tax Return
(ITR) from BIR however, I do not have one as I earned below minimum wage being a
Barangay Volunteer earning for a living honorarium worth of Six Thousand Pesos
(P6,000) per month. Attached hereof copy of Certification from Barangay marked as
ANNEX A;

3. As a matter of fact, I belong to the indigent families in barangay. To prove

this allegation, hereto attached the Certification from our Punong Barangay Hon.
Severino Medalla and marked as ANNEX B;

4. That since I do not have any taxable income, under the law, I am exempted
from filing an Income Tax Return (ITR) with BIR;

5. That I am executing this affidavit to attest to the truthfulness and veracity of

the foregoing statements, to support my sons application and for whatever legal
intents and purposes it may serve.

Affiants further sayeth naught.

IN WITNESS WHEREOF, I have hereunto set my hand this 21st day of June
2017 at Tanauan City, Batangas, Philippines.

SOFRONIO C. MEDALLA
Affiant

SUBSCRIBED AND SWORN to before me this 20th day of June 2017 at

Tanauan City, Batangas, Philippines, Affiant exhibiting to me his identification card
bearing his picture and signature to prove his identity.

HEART C. LERO
Public Attorney I
(Pursuant to R.A. 9406)