REPUBLIC OF THE PHILIPPINES )

PROVINCE OF AGUSAN DEL SUR )S.S

MUNICIPALITY OF SAN FRANCISCO)

AFFIDAVIT OF ADJUDICATION BY SOLE

HEIR OF ESTATE OF DECEASED PERSON

I, AMALIA MANCIO-TELMOSO, of legal age,married and a resident

of Ganayon, Lianga, Surigao del Surr, after being duly sworn to in
accordance with law hereby depose and say:

1) That I am the only surviving heir (daughter) of the late

DOMINGO MANCIO who died intestate in the Municipality of
Lianga, Surigao del Sur, Philippines, on
__________________ ;

2) That said deceased left a valuable asset consisting of a

real property known as Cad Lot No. 980 D, located in
Ganayon, Lianga, Surigao del Sur containing a total area
of two hundred sixty four (264) square meters, bounded as
North, 09 (1650) East,Sec. 014 South, 19 (1648) and the
West, Brgy. road ;

4) That said deceased left no debts;

5) That pursuant to Rule 74, Sec. 1 of the Rules of Court, I

hereby adjudicate unto myself the above-described asset
for purposes of titling, tax payment, collection,
withdrawal and encashment in a banking institution and for
such other purposes by means of this affidavit and hereby
files same with the duly constituted authorities and with
the request that said adjudication be made effective
without judicial proceedings as prescribed by the
aforementioned Rules of Court.

6) That I am executing this affidavit for whatever purposes

legal and legitimate

IN WITNESS WHEREOF, I have hereunto set my hand this 15 th

day of February 2020 at San Francisco, Agusan del Sur.

AMALIA MANCIO-TELMOSO
(affiant)
CTC No. on
at
 ACKNOWLEDGMENT

BEFORE ME, this _____ day of ___________ 2020 at San

Francisco, Agusan del Sur, personally appeared the above-named
persons represented to me to be the same persons who executed the
foregoing instrument, and they acknowledged to me that the same
are their free acts and deeds.

This instrument consisting of two (2) pages including this

page has been signed by the parties and their witnesses at the
left margin of each and every page hereof.

WITNESS MY HAND AND SEAL, the day, year, and place above-
mentioned.

LEON O. MONTILLA, JR.

Notary Public
Until December 31, 2022
IBP Lifetime No. 03110
Doc. No. PTR No. on
Page No. at Agusan del Sur
Book No.
Series of 2020