Republic of the Philippines )

C I T Y OF D I P O L O G ) S.S.
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AFFIDAVIT

I, CHONA DE LA CRUZ GALONG, Filipino, of legal age, and resident of Igot, Estaka,
Dipolog City, after having been sworn to an oath in accordance with law, do hereby declare
that:

I am the eldest child of my mother, Josefina Bagalanon Palpagan, who died on February
5, 1998;

That, my mother co-owns, together with her siblings, a property situated in Lumanao,
Ma. Uray, Dapitan City registered as OCT P-11551 with a total area of 2.7977 hectares;

That, my mother owns a total interest of one-fourth (1/4) of the aforementioned

property;

That, since my mother has already passed away, I designate myself as administrator of
the one-fourth (1/4) share of my mother;

That, I am executing this sworn affidavit in good faith, freely and voluntarily and to
attest to the truthfulness of the foregoing statement, for whatever purpose it may serve;

IN WITNESS WHEREOF, we have hereunto affixed our signatures this 11 th day of

November, 2016, at Dipolog City, Philippines.

CHONA DE LA CRUZ GALONG

Affiant
PhilHealth Number 19-089743325-0

SUBSCRIBED, SIGNED, AND SWORN TO in my personal presence, this 11 th day of

November, 2016, at Dipolog City, Philippines, affiant identified through her competent proofs
of identity, the particulars of which are above-mentioned, which bear her photograph and
signature, and who avowed under penalty of law to the whole truth of the contents of the
instrument or document, which she executed freely and voluntarily.

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Series of 2016.