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Sworn Declaration of Facts of Death: After Having Been Sworn To in Accordance With Law Hereby Depose and Say That

Adelia A. Aceret declares the death of her husband, Jovencio Robles Aceret, who died on February 1, 2024, due to fatal arrhythmia following a myocardial infarction. He had recently undergone surgery and was hospitalized for chest pain prior to his death. This affidavit is executed to attest to the facts surrounding his death for legal purposes.

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Roque M. Riveral
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11 views1 page

Sworn Declaration of Facts of Death: After Having Been Sworn To in Accordance With Law Hereby Depose and Say That

Adelia A. Aceret declares the death of her husband, Jovencio Robles Aceret, who died on February 1, 2024, due to fatal arrhythmia following a myocardial infarction. He had recently undergone surgery and was hospitalized for chest pain prior to his death. This affidavit is executed to attest to the facts surrounding his death for legal purposes.

Uploaded by

Roque M. Riveral
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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SWORN DECLARATION of FACts of death/ adelia a.

aceret

REPUBLIC OF THE PHILIPPINES )


Laoag City ) Ss.

SWORN DECLARATION OF FACTS OF


DEATH

I, ADELIA A. ACERET, of legal age, widow, Filipino, and a resident of


Barangay #4 Sta. Maria, Vintar, Ilocos Norte, Philippines, after having been
sworn to in accordance with law hereby depose and say that:

1. Pursuant to this Affidavit, I am the surviving spouse of Jovencio Robles


Aceret;

2. He has undergone an hernia surgery on December 2023; On January


29, 2024 he was confined in St. Camillus De Lellis General Hospital due to
pain in his chest and could hardly breathe;

3. He had an admitting diagnosis of Silent Myocardial Ischaema/


Hypertensive Cardiovascular Disease; He had also the same Discharge
diagnosis; We were shocked because we were not aware that he was
suffering with the same illness;

4. On January 31, 2024, he was discharged from the hospital; However, on


February 1, 2024, after cooking, I heard him shouting asking for his
medicines: I rushed to attend to him and immediately assisted him take
his medicines; After that, I called for help and the husband of my niece
came; He vomited and even peed himself and died;

5. The decedent died on February 1, 2014 at 12:00 PM, in Bacarra, Ilocos


Norte, Philippines because of reasons, viz:

Immediate Cause: Fatal Arrhythmia


Antecedent Cause: Myocardial Infarction
Underlying Cause: Acute Coronary Syndrome

6. I am executing this affidavit to attest to the truth of the foregoing facts


and for whatever legal purposes it may serve;

FURTHER AFFIANT SAYETH NAUGHT.

IN WITNESS WHEREOF, I hereunto affix my signature this ________ at


Laoag City, Ilocos Norte, Philippines.

ADELIA A. ACERET
Affiant
OSCA ID No. 8848

SUBSCRIBED AND SWORN to before me this _______________ at


__________________, Affiant exhibiting to me her Identification Card as proof of
her identity.

Doc No. ________;


Page No. _______ ;
Book No. _______;
Series of 2024.

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