REPUBLIC OF THE PHILIPPINES)

CITY OF __________.) S.S.

AFFIDAVIT OF FUNERAL EXPENSE

I, ________ of legal age, Filipino, widow and a resident of

________________ after having been duly sworn to in accordance with law,
hereby depose and state that:
1. I am the wife of the late ___________, who died at ___________________
on the _____ day of __________ 2016;
2. The said deceased is buried at the __________________________________;
3. The following are the lists of the funeral expenses for the burial of my
late husband:
Tomb and gravestone
Burial Service c/o San Fernando F.H.
Burial Permit
Labor
Payment for Mass
Vigil Candle/Fresh Flowers
Drinks and Snacks

P 3,600.00
18,000.00
400.00
300.00
1,000.00
2,500.00
420.00

TOTAL:

P 26,220.00

4. I am executing this affidavit to attest to the veracity of the foregoing

funeral expenses and for whatever legal purposes it may serve.
IN WITNESS WHEREOF, I have hereunto affixed my signature this ___
day of _________ 2016 at ______________, Philippines.

__________________________
Affiant

SUBSCRIBED AND SWORN TO before me this _____ day of ____________

2016 at ____________, Philippines, affiant being personally known to me and
exhibiting her Voters ID with VIN: ____________ issued by Commission on
Elections, ___________ City.

Doc. No.
Page No.
Book No.
Series of 2016.