REPUBLIC OF THE PHILIPPINES )

MUNICIPALITY OF SAN JUAN ) SS.

PROVINCE OF LA UNION )

AFFIDAVIT OF LOSS

I, FEDERICO BERMUDEZ, of legal age, married, Filipino citizen and a resident of Brgy.
Talogtog, San Juan, La Union after having been duly sworn on oath in accordance with law
hereby voluntarily depose and say:

1. That I own a memorial lot at Vista del Cielo anent CO # 139; PA # 408;
2. That said lot is located at Phase 2; Section 5; Block 26; and designated as Lot G of Vista del
Cielo (RPG/ G1/ 28 / 23);
3. That I was issued a Certificate of Ownership over the same memorial lot property but due
to inadvertence and my advance age, I could no longer recall where I placed it despite exerting
diligent effort to locate the same;
4. That it appears that the Certificate of Ownership was included in condemned remnants of
our household properties we threw away when our barangay was hit by strong typhoon last year
which caused rain waters to penetrate our house dwelling and caused a lot of our household
properties to be soaked with rain water including papers and documents we could no longer
identify as they were totally damaged beyond recognition, thus were condemned and thrown
away for good;
5. That as a consequence of a death in our family (my sister in law, Tomasa Laconsay) for
which I consented to having said memorial lot be used for her final resting place, I am now asking
Vista del Cielo to facilitate the release of the required papers and documents in order that we
can lay to rest our dead on the said memorial lot which I own;

6. That I only found out of the loss when I started looking for it 2 days ago and that all my
effort to locate the subject Certificate of Ownership has become futile and considered lost
forever and can no longer be found;
7. That I am executing this affidavit to attest to all the above facts and to support our
transaction with Vista del Cielo relative to subject memorial lot as described from the foregoing
and for all legal intents and purposes it may serve.

IN WITNESS WHEREOF, I have hereunto signed my name below, this 20th day of October,
2020 at San Juan, La Union, Philippines.

FEDERICO BERMUDEZ
Affiant
OSCA ID No.104545; 6/22/99 (SJLU)

SUBSCRIBED AND SWORN to before me, this 20th day of October 2020 in San Juan, La Union
and affiant exhibited to me his competent proof of identity as stated below his signature and
printed name above.

__________________________
Notary Public