REPUBLIC OF THE PHILIPPINES)

DONE: IN THE CITY OF BAGUIO) SS

X ------------------------------------------X

AFFIDAVIT
I, MATH MENDOZA, of legal age, Filipino citizen, and a resident of 62 Sto, Tomas Proper,
Baguio City, after having been duly sworn to in accordance with law, depose and say:

1.That I am the owner of a motor vehicle more particularly described as follows:

MAKE . . . HONDA CITY

MOTOR NO.. . . L13A31804163
CHASSISS NO. . . . MRHGD65703P010457
PLATE NO. . . . XNG 856

2. That I personally contacted a private mechanic/painter to caused the change of color of the above
described motor vehicle from NOT INDICATED to MAROON;

3. That I executing this affidavit to attest to the truth of the foregoing statements particularly to
request the concerned government office to cause the correction of the records as well as the entry in
the Certificate of Registration of the above motor vehicle in order to reflect the current color thereof as
disclosed above, and for all legal intents and purposes this instrument may well serve.

AFFIANT FURTHER SAYETH NAUGHT.

MATH MENDOZA
Affiant

SUBSCRIBED AND SWORN to before me this 22 th day of JUNE 2017 in Baguio City,
Philippines. Affiant presenting competent proof of identification indicated under her typewritten name.

Doc. No. ___, Page No. ____

Book No. ___, Series of 2017.