REPUBLIC OF THE PHILIPPINES)

QUEZON CITY
) S.S.
x-------------------------------------x

AFFIDAVIT OF SELF-ADJUDICATION

I, JOSEFINA G. BAG-AO, of legal age, Filipino, and a resident of Blk. 85 Lt. 14,
Daffodil Street, Brgy. Rizal, Makati City, after having been duly sworn to in accordance
with law, depose and state:
1. That I am the sole heir of DOMELICIANO F. BAG-AO who died
without any last will and testament on May 13, 2015 in Makati City;
2. That at the time of his death, he had no debts, liabilities or obligations to
any persons, agency or institution;
3. That the only property he left is a parcel of land consisting of 170 square
meters located in Blk. 85 Lt. 14, Daffodil Street, Brgy. Rizal, Makati City,
more particularly described as follows:
OCT No. 8915 A parcel of land (Lot 14, Blk. 85, of the
subdivision plan Psd-13-005204, being a partion of plan
Swo-13-000410, L.R.A. Record No.
), situated in the
Brgy. of Pembo (Rizal), City of Makati, Metro Manila,
Island of Luzon. Bounded on the NW., along line 1-2 by
Lot 33, Block 85; on the NE., along line 2-3 by Road Lot
118; on the SE., along line 3-4 by Lot 16; and on the SW.,
along line 4-1 by Lot 15, both of Block 85, all of the
subdivision plan. Beginning at point marked 1 on
plan, being S. 41 deg. 28 E., 4494.85 m. from BLLM No.
1, MCadm. 571-0, Makati Cadastral Mapping, thence:
N. 52 deg. 48E.,
S. 37 deg. 04E.,
S. 52 deg. 03W.,
N. 38 deg. 03W.,

17.55 m. to point 2;
9.64 m. to point 3;
17.39 m. to point 4;
9.87 m. to the point of

beginning, containing an area of ONE HUNDRED

SEVENTY (170) SQUARE METERS, more or less. All

points referred to are indicated on the plan and are

marked on the ground by: PS cyl. conc. mons. 15 x 40
cm., bearings grid.
4. That pursuant to Rule 74, Sec. 1 of the Rules of Court, I hereby adjudicate
unto myself the above-described real estate by means of this Affidavit and
hereby files the same with the Register of Deeds of Makati City with the
request that the said adjudication be made effective without judicial
proceeding as prescribed by the aforementioned provision of the Rules of
Court.
IN WITNESS WHEREOF, I have hereunto set my hand this 17th day of August
2015 in Quezon City, Metro Manila, Philippines.

JOSEFINA G. BAG-AO
Affiant

SUBSCRIBED AND SWORN BEFORE ME, a notary Public for Quezon City,
Metro Manila, Philippines, this _______day of _________________ personally appeared
the affiant, JOSEFINA G. BAG-AO, with her Office of Senior Citizen Affairs City of
Makati ID No. 51383, known to me to be the same person who executed the foregoing
instrument. The party acknowledged to me that the same is her own free act and
voluntary deed.

WITNESS MY HAND AND SEAL, on the date and place above written.

NOTARY PUBLIC

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