REPUBLIC OF THE PHILIPPINES )

Province of METRO MANILA ) S.S.

City/Municipality of MUNTINLUPA )
x-----------------------x

AFFIDAVIT OF LOSS

I, MA. RHIA G. MONTECILLO, Filipino, of legal age, and a resident of #4

Diamond St. Francis 3, San Pedro, Laguna, after being duly sworn in accordance with
law, depose and state:

1 That I am the daughter of RODOLFO GONZALEZ the owner of Certificate

of Ownership/Purchase Agreement with FOREST LAKE MEMORIAL
PARK.

2 That sometime on November 8, 2013 the said Certificate of

Ownership/Purchase Agreement misplaced and got lost.

3 That despite diligent search and efforts to locate the said Certificate of
Ownership/Purchase Agreement, I could not find the same such that I now
believe that they are now lost beyond recovery.

4 As such, I am executing this Affidavit of Loss to attest to the truth of the

foregoing facts.

IN WITNESS WHEREOF, I have hereunto set my hand this 18 th day of

February, 2020 at Muntinlupa City, Philippines.

MA. RHIA G. MONTECILLO

AFFIANT

SUBSCRIBED AND SWORN to before me, this 18th day of February, 2020, by
the Affiant who is personally known to me and whom I have identified through competent
evidence of identity No._______________________ issued by _________________.

Doc. No. ______;

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