REPUBLIC OF THE

  )
PHILIPPINES
PROVINCE OF AAA   )  S.S.
MUNICIPALITY OF
  )
BBB
     
AFFIDAVIT OF
   
ADJUDICATION
     
     I, ABC, of legal age, Filipino, single and a resident of No. 123 Municipality
of AAA, Province of BBB, Philippines, after having been duly sworn in
accordance with law, do hereby depose and say:
     
1. That I am the only daughter of X who died intestate ini the Municipality of
AAA, Province of BBB, on April 08, 2002 as evidenced by Death Certificate
issued by the Municipality of AAA, Province of BBB, hereto attached as
ANNEX “A” and made an integral part of this Affidavit;
     
2. That the said deceased left deposit in the Rural Bank of AAA, Inc., in the
amount of P300,000;
     
3. That the said deceased left no debts;  
     
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 BBB with the request that
the said adjudication be made effective without judicial proceeding as
prescribed by the aforementioned Rules of Court.
     
     IN WITNESS WHEREOF, I have set my hand this _____ day of
____________ 2011 at Municipality of AAA, Province of BBB, Philippines.
    ABC
    Affiant
   

    SUBSCRIBED AND SWORN before me this ____ day of ____________

2011 at Municipality of AAA, Province of BBB, Philippines.
     
    CCC
    Notary Public
Commission to
   
expire:______
    IBP No., Place, Date
    PTR No., Place, Date
     
Doc. No.________    
Page No. _____    
Nook No. ________    
Series of _________