REPUBLIC OF THE PHILIPPINES

CITY OF URDANETA } S.S.

AFFIDAVIT
OF NO IMPROVEMENT
I, CONCHA BUGAY, of legal age, Filipino citizen, married, and a resident of
Barangay San Vicente, Urdaneta, Pangasinan, after having sworn to in accordance with
law hereby depose and state that:

1. I am the transferee/registered owner of a parcel of land situated at Brgy. San

Vicente, Urdaneta City, Pangasinan covered by Transfer Certificate of Title No. 217311 of
the Registry of Deeds for Pangasinan, containing an area of FIFTY-TWO (52) square
meters, more or less;

2. The above parcel of land is a vacant lot since there are no improvements or
structures built thereon whatsoever;

3. I am executing this affidavit to attest to the truth of the foregoing statements

and for whatever legal purpose it may serve.

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

January 2020 at Urdaneta City, Pangasinan.

______________
CONCHA BUGAY
Affiant

SIGNED IN THE PRESENCE OF:

________________________ _________________________
Witness Witness

SUBSCRIBED AND SWORN to before me on the place and date abovewritten,

affiant presenting to me as competent proof of identity, her __________________
valid until _____________, issued at _______________________.

Doc No. : ____

Page No. : ____
Book No. : ____
Series of 2020.