Affidavit of Consent For Cremation Proforma

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Republic of the Philippines )

Province of Misamis Occidental )


City of Ozamiz ) SS

AFFIDAVIT OF CONSENT FOR CREMATION

We, the undersigned, all of legal age, Filipino citizens, with


residences indicated below, after having been duly sworn to in accordance
with law that:

1) We whose names appear here, are the surviving children of


+DON PEPOT (deceased) and +DOÑA PATPAT (deceased);

ELDEST CHILD, single/married and a resident


of _________________________________
__________________________________________.
SECOND CHILD, single/married and a resident
_________________________________
__________________________________________.
THIRD CHILD, single/married and a resident of
_________________________________
__________________________________________.
FOURTH, married, and a resident of
______________________________
___________________________________________.
FIFTH CHILD, single/married and a resident of
_________________________________
__________________________________________.
And

SIXTH CHILD, single/married and a resident of


_________________________________
__________________________________________.

2) Our other sibling ______________________ has been deceased for


_____ years/months;

3) Our mother DOÑA PATPAT died on ______________ ___, 2011


at San Francisco City, California, United States of America;

4) We agree to have the remains of our mother cremated to honor


her request communicated to us orally prior to her demise;

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5) We hereby give our full consent for the cremation of her remains
to be supervised by our sister _______________________________
who resides at _________________, _________________, United
States of America;

6) We are executing this affidavit to attest to the truth of the


foregoing facts and to support the request US Authorities in
order to;

IN WITNESS WHEREOF, we hereunto affix our signatures this


_____ day of ________________________ in Ozamiz City, Philippines.

Date of
Affiants Valid ID
Issue/Validity

ELDEST CHILD

SECOND CHILD

THIRD CHILD

FOURTH

FIFTH CHILD

SIXTH CHILD

ACKNOWLEDGMENT

REPUBLIC OF THE PHILIPPINES)


CITY OF OZAMIZ . . . . . . . . . . . . . .) S.S.

BEFORE ME, a Notary Public for and in the Province of Misamis


Occidental, City of Ozamiz, Municipality of Clarin and Tudela, on this
___day of __________________ personally appeared the parties and their
witnesses, known to be the same persons who executed the foregoing
instrument and acknowledged to me that the same is their own free
act and voluntary act and deed.
This instrument, consisting of ________ page/s, including the
page on which this acknowledgment is written, has been signed on
the left margin of each and every page hereof by the concerned
parties and their witnesses, and sealed with my notarial seal.
WITNESS MY HAND AND SEAL, at the place and date above-
written.

Notary Public

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