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REPUBLIC OF THE PHILIPPINES ) BUTUAN CITY ) S.S.
AFFIDAVIT OF LOSS
I, LOVELY T. PUQUES , of legal age, Filipino and a resident of P-2A Pigdaulan, Butuan City, after having been duly sworn according to law hereby depose and state: 1. That I am the Librarian/ Property Custodian of Pigdaulan National Highschool; 2. That sometime in the school year 2016 to 2017, the following books were misplaced or lost: NO. OF BOOKS
3 2
4 6 2 3 1 4 2 2 4 6 3 7 6 5 5 12 8 11 1
TITLE OF BOOKS OLD BOOKS Science and Technology II Mathematics III (Geometry Tx) FOR GRADE 7 Household Services LM Horticulture Services LM Household Services LM Arts LM Horticulture TG FOR GRADE 8 Asya sa Gitna ng Pagkakaiba LM Edukasyon sa Pagpapakatao LM Music and Arts LM Panitikang Filipino LM PE and Health Science FOR GRADE 9 Araling Panlipunan: Kasaysayan ng Daigdig LM English- Anglo American Literature LM Edukasyon sa Pagpapakatao Filipino- Panitikang Asyano Music and Arts P.E. & Health Science FOR GRADE 10 Edukasyon sa Pagpapakatao
18 6 3 8 5 4 6
Ekonomiks English Filipino Mathematics Music and Arts P.E. and Health Science
3. That despite diligent efforts to locate and/or find the above-mentioned books, the same could no longer be found. 4. That I attest to the truth of the foregoing facts. FURTHER AFFIANT SAYETH NONE. IN WITNESS WHEREOF, I have hereunto set my hand this 5 day of May, 2017 at Butuan City. th
LOVELY T. PUQUES Affiant
SUBSCRIBED AND SWORN to before me this 5 th day of May, 2017 affiant exhibiting her PRC I.D. No. 1136931 as proof of her identity.
Doc. No.: _________ Page No.: _________ Book No.: _________ Series of 2017
ATTY. PEARL JOY M. SALAS NOTARY PUBLIC
Commission until December 31 2017 Roll No. 65035 IBP NO. 1061793 / 01-10-2017 PTR NO. 1260135 I 01-04-2017 /Butuan City MCLE Compliance: Admitted to the Bar on 06-172016 TIN: 488-196-768 Purok-3 Libertad, Butuan City