REPUBLIC OF THE PHILIPPINES)

CITY OF SAN FERNANDO ) S.S.

PROVINCE OF LA UNION
x-------------------------------------x

AFFIDAVIT OF SELF-ADJUDICATION

I, ALBERT C. ALGUIZA, of legal age, Filipino, and a resident of Central East,

Bauang, La Union after having been duly sworn to in accordance with law, depose and
state:

1. That I am the only son of EVELYN C. ELGUIZA who died without any last will and
testament on February 05, 2018 in Bauang as evidenced by his Death Certificate issued
by Bauang, La Union hereto attached as Annex “A” and made an integral part of this
Affidavit;

2. That at the time her death, my mother had no debts, liabilities or obligations to any
persons, agency or institution;

3. That the only property she left is a parcel of land consisting of 1,259 square meters
located in Bacnotan La Union more particularly described in OCT No. 025-
CARP20160000607 hereto attached as Annex “B” and made an integral part of this
Affidavit;

4. That pursuant to Rule 74, Sec. 1 of the Rules of Court, I hereby adjudicate unto
myself the above-described real estate by means of this Affidavit and hereby files the
same with the Register of Deed of La Union City with the request that the said
adjudication be made effective without judicial proceeding as prescribed by the
aforementioned provision of the Rules of Court.

IN WITNESS WHEREOF, I have hereunto set my hand this 24th day of February
2018 in Bauang, La, Philippines.

ALBERT C. ALGUIZA
Affiant

SUBCRIBED AND SWORN TO before me this 24th day of February 2018 in

Pagdaroan, San Fernando, La Union, Philippines, affiant exhibiting to me his Philippine
Passport No. 123456 issued in Manila on January 12, 2014 and valid until January 12,
2019.

Doc.No.8
Page No. 15
Book No. 1
Series No. 2018

Atty. Shiela Joy. B. Corpuz

Notary Public for La Union
Commission Serial No.1234 Until December 31, 2018
San Fernando, La Union
Roll of Attorney No. 0905
PTR No. 5678/San Fernando/052416
IBP No.1111/121690/La Union