Republic of the Philippines )
Province of_________________) S.S.
City/Municipality of __________)
x------------x
AFFIDAVIT OF DESISTANCE
I,__________, of legal ages, Filipino,(single / married / widow), and a resident of
____________, Philippines, after having been duly sworn in accordance with law,
hereby depose and say:
That I am the private complainant in the criminal case entitled "____________";
for Theft docketed as____________before___________Trial Court, Branch
_____,__________City, Philippines;
That I found out that the said accused at the time of the incident was not in his
right mind and did not know that what he was doing was wrongful and criminal
considering that he was suffering from Schizophrenia, Paranoid Type in acute
exacerbation as certified to by Dr.____________of____________;
That the items taken by the accused, consisting
of____________and____________were immediately recovered from him and
their values had been voluntarily reimbursed by the relatives of the said Accused;
In view of the foregoing, I finally manifest that I now completely and absolutely
exonerate the accused__________from any liability in connection with the above-
mentioned criminal case and that I am no longer interested, and I hereby desist, in
prosecuting the said criminal case;
That I execute this Affidavit of Desistance so that the above-mentioned criminal
case be immediately dismissed and considered finally closed and the bond posted
by the herein accused be released to him;
As such, I am respectfully praying that the aforementioned case against the
Accused____________ be dismissed and finally closed.
IN WITNESS WHEREOF, I have hereunto set my hand
this____________at__________City, Philippines.
Affiant
(JURAT)
REPUBLIC OF THE PHILIPPINES )
Province of____________________ ) S.S.
City/Municipality of_____________ )
I HEREBY CERTIFY that the affiant personally appeared and subscribed to me
her Affidavit of Desistance consisting of ___ (_) pages before me this ___ day
of____ 20__ at _______ and that I have personally examined her and I am satisfied
that she voluntarily executed and understood its contents.
Prosecutor
OFFICE OF THE______PROSECUTOR
City/Municipality of __________