REPUBLIC OF THE PHILIPPINES) CITY OF DIPOLOG ) S.S. X--------------------------------------------/
AFFIDAVIT OF SELF-ADJUDICATION I, _________________, Fili Filipi pino no,, of lega legall age, age, marr marrie ied d and and resi reside dent nt of Miputak, Dipolog City, under oath hereby deposeth and sayeth: That I am the only surviving heir of _________, who died intestate in the City of Dipolog on October 27, 2002, without leaving any indebtedness; That said deceased person at the time of her death left the following properties: 1. A parcel parcel of land known known as Lot No. 1008-B-2 1008-B-2,, particula particularly rly described described as as follows: follows: A parcel of land known as Lot No. 1008-B-2, of the subdivision plan (LRC) Psd951528, being a portion of Lot 1008-B, as described on plan Psd-541658, situated in the ______ _________ ___,, Munici Municipa palit lity y of Dipol Dipolog, og, Provin Province ce of Zambo Zamboang anga a del Norte Norte,, contai containin ning g an area area of ______ _________ ______ ______ ______ ___,, more more or less, less, covere covered d by Transf Transfer er Certificate of Title No. T-1565158 of the Registry of Deeds of Dipolog City, the exact description of which is indicated on the face of the aforesaid certificate of title. 2. A parc parcel el of land land know known n as Lot Lot No. No. 1052 105208 08-B -B-3 -3,, part partic icul ular arly ly desc descri ribe bed d as follows: A parcel of land known as Lot No. 100518-B-3, of the subdivision plan (LRC) Psd-95524098, being a portion of Lot 1008-B, as described on plan Psd-53678, situated situated in the Poblacio Poblacion, n, Municipa Municipality lity of Dipolog, Dipolog, Province Province of Zamboanga Zamboanga del Norte, Norte, containi containing ng an area area of ______ ________ __ (358 (358 SQ.M.) SQ.M.),, more more or less, less, covere covered d by Transfer Certificate of Title No. T-16786 of the Registry of Deeds of Dipolog City, the exact description of which is indicated on the face of the aforesaid certificate of title. 3. A resident residentia iall house house built built on a portio portion n of Lot No. ______, ______, situate situated d at Dipolo Dipolog g City.
That pursuant to the Rules of Court, I, being the only heir of said decedent, do hereby adjudicate unto myself the above-described properties by means of this Affidavit of Self-Adjudication and which is filed with the Office of the Registry of Deeds of Dipolog City, with the request that said adjudication be made effective without judicial proceedings, and that the title of the above-des above-describe cribed d properties properties be cancelled cancelled,, and that new certificates certificates of title be issued in my name; That this Affidavit of Self-Adjudication Self-Adjudication is published in the Dipolog Chronicle for three (3) consecutive weeks. IN WITNESS WHERE EREOF, I hereunt unto affix __________________, __________________, 2004 at Dipolog Dipolog City, Philippines. Philippines.
my
signature ure
this
_____________ Affiant SUBSCRIBED AND SWORN to before me, this ________________________, 2004, in the City of Dipolog, affiant exhibiting his Community Tax Certificate No. _____________, issued on _______________, at ____________________________.
Doc. No. _____: Page No._____:
Notary Public
Book No.______ Series of 2004.
Until December 31, 2005 PTR No. 44325127 01-14-04 IBP No. 605510 01-08-04 ____ City
