Republic of the Philippines)

Province of Leyte )
Baybay City ,Leyte ) S.S

AFFIDAVIT OF NO PENDING
ADMINISTRATIVE AND CRIMINAL CASE

I, AZUCENA POLO - MIRAMBEL of legal age, married with residence

address at Guadalupe , Inopacan, Leyte, after being duly sworn to in accordance with
law, hereby depose and state that:

1. I am the Local Chief Executive of the Municipality of Inopacan, Leyte;

2. There is no complaint(s) against the undersigned pending with the Civil Service
Commission, Office of the Ombudsman, any Prosecutor’s Office, Department of
Justice, or any regular courts or the Court of Appeals and the Supreme Court; or
pending administrative case with the Commission on Audit or any
Administrative body; and

3. I am executing this sworn statement to lend to the veracity of the foregoing

statement and for whatever legal purpose or purposes that it may serve.

AFFIANTS FURTHER SAYETH NAUGHT.

IN WITNESS WHEREOF, I have hereunto set my hand this October 16, 2019 at
Baybay City, Leyte , Philippines

AZUCENA POLO - MIRAMBEL .M.D. F.P.O.G.S

Affiant

SUBSCRIBED AND SWORN to before me this October 16, 2019 at Baybay

City, Leyte, Philippines, affiant exhibiting to me her Physician’s Identification Number
0058417 valid until April 11,2022 issued by the Professional Regulation Commission ,
Sampaloc, Manila, Philippines.

ATTY. LUCILLE M. TEVES

Notary Public for RTC Baybay City, Leyte
Doc. No. ____; Notarial Commission No. B – 19 -05-09
Page No. ____; until Dec.31,2020
Roll of Attorneys No. 66995
Book No. ____; IBP No. 45424569;January 8,2019 Leyte Chapter
Series of 2019. PTR No. 3148217; April 4,2019; Baybay City, Leyte
MCLE CompliIance No. VI – 001084
TEVES LAW OFFICE
San Mauro St., Baybay City, Leyte
lcmteves@yahoo.com
Doc. No. ______;
Page No. ______;
Book No.______;
Series of ______.