REPUBLIC OF THE PHILIPPINES)

PROVINCE OF TARLAC : S.S.

MUNICIPALITY OF BAMBAN )

AFFIDAVIT OF SELF-ADJUDICATION OF
SOLE HEIR OF DECEASED PERSON

I, _________________________________, of legal age, Filipino, widow of

the late _________________________________, with residence and postal
address at _________________________________, after having been duly
sworn to in accordance with law, do hereby depose and say:

THAT—

1. My late husband, _________________________________ and I are

legally married, copies of our Marriage Contract is attached as
Annex “A”, and his Certificate of Death as Annex “B” to form
an integral part hereof;

2. During our marriage, my husband and I did not begot any

children;

3. Thus, I am the only surviving heir of the late

_________________________________;

4. The Deceased left a certain Real Estate Property containing

an area of _________________________________, more or less,
situated in the _________________________________, covered
and described by Transfer Certificate of Title No.
_________________________________, issued by the Register of
Deeds of Tarlac, which property is more particularly described
as follows:

TRANSFER CERTIFICATE OF TITLE No.

_________________________________

5. Said deceased left no debts;

6. Pursuant to Rule 74, Sec. 1 of the Rules of Court, I hereby

adjudicate unto myself the above described parcel of land by means of
this Affidavit and hereby files same with the Register of Deeds of Tarlac,
with request that said adjudication be made effective without judicial
proceedings as prescribed by the aforementioned Rules of Court;

IN WITNESS WHEREOF, I have hereunto affixed my signature this

26th day of June 2019 at Brgy. O`Donnell, Capas, Tarlac, Philippines.

Page 1 of 2
 _________________________________
Affiant
ID No. _________________________
Valid Until: _______________

SUBSCRIBED AND SWORN to before me this 26th day of June 2019

at Bamban, Tarlac, Philippines, affiant exhibited to me her positive
identification duly noted above below her name and signature, known to
me and to me known to be the same person who executed foregoing
Affidavit and acknowledged to me that the same is her free act and deed
and that she voluntary executed the same and understood all the
contents thereof.

WITNESS MY HAND AND SEAL.

Doc. No. _____;

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

Page 2 of 2