Republic of the Philippines )

Province of Nueva Ecija ) S.S.

Municipality of
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A F F I D A V I T OF TRANSFEROR
I , _____________________________, of legal age, Filipino, and a resident of
Brgy. Tagpos, Sta. Rosa, Nueva Ecija, after having been duly sworn to in accordance
with law hereby depose and say:

1.) My total land holding s including that

That, I am executing this affidavit in order to attest to the truth of the

foregoing and to establish the fact that we incurred additional expenses in the
amount of P15,000.00 for the memorial lot and P35,000.00 for the wake and
burial of my son FLORENCIO D. PASCUAL .

IN TRUTH OF THE FOREGOING, I have hereunto set my hand this 4 th day of

July 2012, here at Santa Rosa, Nueva Ecija, Philippines.

Affiant

SUBSCRIBED AND SWORN to before me this 4 th day of July 2012, here at Sta.
Rosa, Nueva Ecija.