Republic of the Philippines)

Province of Bohol ) SS
City of Tagbilaran )

AFFIDAVIT OF SETBACK

I, MILA A. FLORES, Filipino, of legal age, married and resident of Upper Calceta
St., Tagbilaran City, Bohol, do hereby depose and say:

1. That I am an applicant of a building permit for the construction of a residential

house on the portion of a certain parcel of land covered by OCT No. 3531/1475,
more specifically on Lot No. 1558-C, with a total land area of Two Hundred
Forty (240) sq. m. located at Cogon Dist., Tagbilaran City, Bohol;

2. That I hereby commit to submit to the minimum specific set back requirements
(3 meters) of the City Government of Tagbilaran, relative to the construction of
my residential house over the subject lot;

3. That I execute this affidavit to manifest my observation on the setback, and

comply with all the setback requirements of the government as well as for all
legal purposes this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this _______________ in

the City of Tagbilaran, Bohol, Philippiness.

MILA A. FLORES
Affiant

SUBSCRIBED AND SWORN to before me this ______________ in the City of

Tagbilaran, Bohol, Philippines affiant exhibited to me her UMID Id with CRN 0111-
4224831-8 as a competent evidence of her identity.

Doc No. _____;

Page No. ____;
Book No. _____;
Series of 2019.