AFFIDAVIT

REPUBLIC OF THE PHILIPPINES)

Province of Zamboanga del Norte)
City of Dipolog City ) SS.
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I, CORA B. SULA-SULA, of legal age, married, and a resident Of Villahermosa,

Polanco, Zamboanga Del Norte, after being duly sworn to in accordance, do hereby
state and depose:

1. THAT I am the registered owner of a parcel of land covered by Transfer

Certificate of Title No. 74626 known as (Lot No. 4029-A) of the subdivision plan,
PSD 09-047573, being a portion of Lot 429 situated at Villahermosa,
Municipality of Polanco, Province of Zamboanga del Norte bounded on the NE
by Lot 4477, on the South by Lot 4030, on the West by Lot 4478, on the NW by
Road Lot 4029 Provincial Road along line -3-10, by Lot 4029, containing an
area of TWENTY SIX THOUSAND ONE HUNDRED NINETY NINE (26, 199) sq.
meters wide;
2. That by operation of Land, I confirm that I have donated permanently a portion
, reserved a road right of way in favour of ZENITH LACAY and NICANOR LACAY
the above mentioned land with an area of six (6) meters wide.
3. That I am executing this affidavit to attest to the truth of the foregoing facts.

IN WITNESS WHEREOF, I hereunto affix my signature this 8th day of

November, 2017 at Dipolog City.

CORA B. SULA-SULA
Affiant

SUBSCRIBED AND SWORN to before me this _______________ at Dipolog

City, Affiant exhibiting to me her Pantawid ID No. 097210029-9998-68994

Doc No. ____

Page No. ____
Book No. ___
Series of 2017.