REPUBLCI OF THE PHILIPPINES PROVINCE OF LA UNION CITY OF SAN FERNANDO

) )S.S )

AFFIDAVIT OF ADJUDICATION I, ___________________, of legal age, married, Filipino citizen and a resident of Poblacion, San Gabriel, La Union, Philippines, after having been duly sworn to in accordance with law, hereby depose and say that: I am the surviving legal heir of the late ________________ who died on _______________ in __________________; The above deceased at the time of his death left a parcel of land particularly described as follows: A pasture land with an area of 2, 282 square meters and an unirrigated Riceland with an area of 200 square meters covered by Tax declaration No. 2009-14-0015-00287. It is designated as Lot No. 2365, Bounded on the North by 13, on the South by 07, on the East by 07, and on the West by Sec. 009. Now therefore, for and in consideration of the premises and invoking the provisions of Section 1, Rule 74 of the Rules of Court, I hereby adjudicate unto myself the said property free from all liens and encumbrances; I am executing this affidavit to attest to the truth and veracity of the foregoing and for all legal intents and purposes. IN WITNESS WHEREOF, I have hereunto set my hand this __________________ at San Fernando City, La Union, Philippines. _________________ Affiant ID No. 13-668 Issued by PGH, Manila

SUBSCRIBED AND SWORN TO before me this __ day of __________ 2013 at San Fernando City, La Union. Affiant exhibited his ID indicated below his name and signature above as competent proof of his identity.