Republic of the Philippines

CITY OF CALOOCAN
CITY HEALTH DEPARTMENT
WAIVER
To whom it may concern:
This is to certify that I, CORAZON TOLENTINO ABUAN, of legal
age, Filipino Citizen, presently residing at No. 49 Malolos Ave., Bagong
Barrio, Caloocan City, after having been duly sworn to in accordance with
law, do hereby depose and say:
That I am the daughter of the late INOCENSIA
TOLENTINO who died on June 10, 1986 in residence;

BUNAG

That I have no complaint regarding the cause of death of the

late INOCENSIA BUNAG TOLENTINO, such being a natural death;
That nobody is to be blamed for his / her death; CARDIAC ARREST
That he/she is not covered by any INSURANCE;
That I hereby request the authorities concerned not to conduct any
autopsy on his/her remains and hereby take full responsibility of such
non-autopsy;
That I will not file any criminal, civil or administrative case against
any third person/s;
That I hereby affirm that I executed this waiver voluntarily and
without any force of intimidation from any individual.
That I am executing this waiver to attest to the truth of the
foregoing facts for all legal intents and purposes.
IN WITNESS WHEREOF, I have hereunto set my hand this May 19,
2016 in Caloocan City.
ABUAN

CORAZON

TOLENTINO

Affiant Nearest

of Kin
ID

No.

S-1466

(Senior

SUBCRIBED
AND
SWORN
TO before
this _____________________ in
_________________, Philippines,
exhibiting to me their valid proofs of identification.

me
affiants

Citizen ID)

Doc. No. _____;

Page No. _____;

Book No. _____;

Series of 2016