REPUBLIC OF PHILIPPINES )

CALOOCAN CITY
) S.S.

AFFIDAVIT OF DENIAL
I, __________________, of legal age, Filipino, married
and
a resident of ________________________________, after having been
duly sworn to in accordance with law, depose and state:
1. That I was born on _________ in Labo, Camarines Norte, Bicol;
2. That I established my permanent residence in Caloocan City, Philippines;
3. That on _______, I applied with the Lung Center to avail of its Social
Services;
4. That I received an information from the Assessors Office of Caloocan City
on August 14, 2015 that there is another person named ________ who
owns a residential land/property situated in Caloocan City which has an
area of ___ square meters.
5. That I hereby unequivocally DENY ownership of the aforementioned
property;
6. That I also declare under oath that I am not the person who owns the
said property;
7. That I am executing this Affidavit to attest to the foregoing facts and to
deny absolutely and entirely ownership of said property and for all
legal intents and purposes.
IN WITNESS WHEREOF, I hereby affixed my signature this 17th day
of August, 2015 in Caloocan City, Metro Manila, Philippines.
__________________________
Affiant
SUBCRIBED AND SWORN TO before me this 17th day of August,
2015 in Caloocan City, Philippines, affiant exhibiting to me his competent
evidence of identity by way of his Senior Citizen I.D. No. ________.
Doc. No. _____;
Page No. _____;
Book No. _____;
Series of 2015.