REPUBLIC OF THE PHILIPPINES)

TRECE MARTIRES CITY, CAVITE) S.S.

AFFIDAVIT OF NON-FILING OF INCOME

I, LORVENA SOLTIS BUSCAS, of legal age, Filipino and a resident of Brgy.

Cabuco, Trece Martires City, Cavite, after having been duly sworn in accordance to law,
depose and say:

1. That I did not file my income tax return for the year 2017 and prior years for the
reason that I have no source of income;
2. That I am among those not required to file an income tax return under Section
44(2)(A)(V) of the National Internal Revenue Code as amended;
3. That this affidavit is executed to the truth of the foregoing statement and for all legal
intent and purposes and in order to facilitate the issuance by the Bureau of Internal
Revenue (BIR) of a tax exemption certificate, for my housing application at the
National Housing Authority (NHA).

IN WITNESS WHEREOF, I have hereunto set my hand and affix my signature this
____day of _______________, 2018 at Trece Martires City, Cavite.

LORVENA S. BUSCAS
Affiant

SUBSCRIBED AND SWORN to before me this _____day of ______________,

2018 at Trece Martires City, Cavite. Affiant exhibited to me his Residence
Certificate No. _______________ issued on __________________ at Brgy.
_________________________________.

NOTARY PUBLIC
DOC. NO. ______;
PAGE NO.______;
BOOK NO._____;
SERIES OF 2018.