TO : THE REGISTRY OF DEEDS

For the Province

of Agusan del Norte

AFFIDAVIT OF LOSS
Of the owner’s duplicate of
OCT no. P-4, covering Lot 2798,
Pls-22 situated in Alubihid,
Buenavista, Agusan del Norte

I, Ma. Theresa D. Bollozos, of legal age,

married, Filipino and resident of JC Aquino
Ave., Butuan City, UNDER OATH, hereby depose and
state –

1. That I am the daughter of the late Juan E.

De los Santos, who died intestate and
without any debts, last September 10, 2010
in Butuan City;

2. That as such, I, together with my siblings,

are his compulsory and legal heirs.
3. That the late Juan E. De los Santos left
several properties, one of which is that
two hectare (20,000 sq. meters, more or
less) portion of lot 2798, Pls-22, situated
in Alubihid, Buenavsita, Agusan del Norte,
embraced and covered by OCT no. P-4, issued
by and on file with, the Registry of Deeds
for the province of Agusan del Norte.

4. The late Juan E. De los Santos acquired

that two hectare (20,000 sq. meters, more
or less) portion of lot 2798, Pls-22, from
one SOFRONIO BIRDOS, legal heir of DIONISIO
BERDOS, the titleholder of the bigger land
under OCT no. P-4.
 In support thereof, attached hereto are the
foregoing –

a. Tax declaration of the 2 hectare portion

of Lot 2798, Pls-22 in my father’s name,
marked as ANNEX “A”;

b. AFFIDAVITS of the late Juan E. De los

Santos and SOFRONIO BIRDOS relating to
the transfer and purchase of the subject
2 hectare portion of Lot 2798, Pls-22,
marked as ANNEX “B”;

c. History of Real Property tax payments of

the subject property, as certified to the
Office of the Provincial assessor of
Agusan del Norte, marked as ANNEX “C”

d. Deed of Absolute sale executed by

SOFRONIO BIRDOS in favor of my father,
marked as ANNEX “D”

5. That since its acquisition and up to the

present time, late Juan E. De los Santos
and now, his heirs, have in open,
continuous, exclusive, adverse, peaceful
and notorious possession thereon in the
concept of owner.

6. By reason of my family’s desire to have the

subject two hectare land segregated from
the mother lot and have the same separately
titled, I and my siblings have exerted all
efforts to locate the owner’s duplicate of
OCT no. P-4, but the same resulted in
futility.

7. I and my siblings have also asked the other

owners of other portions of Lot 2798, Pls-
22, but they also do not know the where the
 owner’s duplicate of OCT no. P-4 is. They
thought that it was with my father.

8. From my recollection, my late father, years

before his death, had in his possession the
owner’s duplicate of OCT no. P-4. However,
after his detah, I personally searched his
personal belongings and papers, but the
owner’s duplicate of OCT no. P-4 was not
there.

9. From all indications, the owner’s duplicate

of OCT no. P-4 is lost and beyond recovery.

10. I respectfully request the Registry of

Deeds of Agusan del Norte to register the
loss of the owner’s duplicate of OCT no. P-
4.

11. I hereby authorize my husband, PEPITO M.

BOLLOZOS, to act on my behalf and do all
acts necessary in connection with this
Affifavit, in my absence.

12. I execute this Affidavit to attest to the

truth of the foregoing.

IN WITNESS WHEREOF, I hereunto affix my

signature this ______________________________ at
Butuan City, Philippines.

Ma. Theresa D. Bollozos

ID ______________________

SUBSCRIBED AND SWORN TO BEFORE ME, this

____________________________________ at Butuan
City, Philippines.