REPUBLIC OF THE PHILIPPINES)

PROVINCE OF BOHOL )
X-------------------------------------X

AFFIDAVIT OF NON-OWNERSHIP

I, ______________________, surviving spouse of _____________________, Filipino, of legal

age and a resident of __________________________, Philippines, after having duly sworn to in
accordance to law do hereby depose and state:

1. That, I and my late husband _____________________ are not the owner of a certain parcels
of land described under _______________________________ declared in the name of
_____________________ located at ____________________ containing an area of TWENTY-
EIGHT THOUSAND SIX HUNDRED FIVE (28,605) SQUARE METERS and
_____________________________ declared in the name of
___________________________ located at ________________________ containing an area
of NINE THOUSAND FIVE HUNDRED TWENTY-FOUR (9,524) SQUARE METERS;

2. That, when I obtained a certification of landholdings at Provincial Assessor’s Office at

Tagbilaran City, there appears the aforementioned two parcels of land as part of our
landholdings which we do not owned;

3. That, I hereby declare that the aforementioned parcels of land located in

_______________________ and ________________________, Phlippines and I hereby
DISOWN ANY PARTICIPATION, INTEREST AND OWNERSHIP over the aforesaid parcels of
land;

4. That upon verification, the above-named parcels of land property belong to persons who
happen to have the same name of my late husband ____________________ and the only
difference is that the owner of the said parcels of land has no middle initial which is
_________________________________ only;

5. That, I am executing this affidavit to attest to the truth of the foregoing facts and to prove
that we have no claim of ownership or any interest over the aforementioned parcels of land
embraced under Tax Declaration No. _____________________ situated at
___________________ and Tax Declaration No. ______________________ situated at
____________________and for whatever legal purposes this may serve best.

IN WITNESS WHEREOF, I hereby affix my signature this __________________ at Poblacion, San

Miguel, Bohol, Philippines.

____________________________
AFFIANT
ID NO. ____________________

SUBSCRIBED AND SWORN TO before me this _______________ at _____________________,

Philippines by affiants who exhibited to me her respective Valid ID as evidence of identity.

Doc. No._________;
Page No._________;
Book No. _________;
Series of 2021.