REPUBLIC OF THE PHILIPPINES)

______________                   )S.S.

  

AFFIDAVIT OF SELF-ADJUDICATION

I, _____________, of legal age, Filipino, single and a resident of

______________________________, after having been duly sworn to
in accordance with law, depose and state:

1.  That I am the only daughter of _____________ who died without any

last will and testament on _______________ in ____________ as
evidenced by her Death Certificate issued by ______________, 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 her ½ share in a parcel of land which
she inherited from _____________, consisting of ____________ square
meters, located in ______________________. A copy of Transfer
Certificate of Title No. _________ covering said property is
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
_____________ with the request that the said adjudication be made
effective without judicial proceeding as prescribed by the
aforementioned provision of the Rules of Court.

5. I hereby execute this Affidavit for the purpose of processing the transfer
of ½ of the parcel of land covered by Transfer Certificate of Title No.
________ in my name, and the settlement of the estates of the late
__________ and ____________.

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

_______________.
          

_____________________
Affiant

  

 SUBCRIBED AND SWORN TO before me this

_________________ in _____________, affiant exhibiting to me her
__________________ valid until ______________.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2020.