(Declaration of Heirship Self Adjudication of Estate of Deceased

Person)
Republic of the Philippines)
Province of ____________________)S.S.
City/Municipality of _____________)
x - - - - - - - - - - - - - - x
AFFIDAVIT
I, _____________, Filipino, of legal age, (single / married /
widow), and a resident of _____________, Philippines, after being
sworn in accordance with law, depose and state:
1. That I am the only child and sole heir of _____________ who
died intestate on _____________ at _____________;
2. That said deceased left a certain parcel of land covered by
Transfer Certificate of Title No. _____________ and more
particularly described as follows:
(Technical Description of Property)
3.That said deceased left no debts, nor any Last Will and
Testament;
4.That pursuant to Sec. 1 of Rule 74 of the Revised Rules of
Court of the Philippines, I hereby adjudicate unto myself the
above-described parcel of land, and the improvements found and
standing thereon, and I hereby request the Register of Deeds to
issue a new Transfer Certificate of Title in my name;
5.That the above-described parcel of land does not come under the
operation of the Comprehensive Agrarian Reform Program.
IN WITNESS WHEREOF, I have hereunto set my hand this
_____________ in _____________, Philippines.
AFFIANT
(JURAT)