REPUBLIC OF THE PHILIPPINES)

PROVINCE OF LA UNION ) Sc.

MUNICIPALITY OF TUBAO )
x-------------------------x

AFFIDAVIT OF TOTAL LANDHOLDINGS

NON-TENANCY, and NON-IMPROVEMENT

I CLARITA BASALLO TALIGAN, of legal age, married to Inucio W. Taligan,

Filipino Citizen and a resident of Garcia, Tubao, La Union, herein, after having been duly sworn
to in accordance with law, hereby depose and state:

a. 1. That I am the Transferee of a parcel of land covered by TAX DECLARATION No.

Tax Declaration No. 2009-12-0011-00851 containing an area of NINE HUNDRED
SIXTY THREE (963) square meters more or less located at San Luis, Pugo, La Union
under the name of SPS SANTIAGO and JOSEFINA BASALLO.

2. My total landholdings do not exceed the limit prescribed by law;

3. That the above-described property has no existing improvement, not tenanted and is
free from liens and encumbrances whatsoever;

4. That I am therefore executing this Affidavit to attest to the truth of the foregoing
statements and for all legal intents and purposes it my serve.

IN WITNESS WHEREOF, I have hereunto set my hand this _____________ at Tubao,

La Union.

CLARITA BASALLO TALIGAN

Affiant
TIN ID No. 268-801-731

SUBSCRIBED AND SWORN to before me this _______________ at Tubao, La

Union by the affiants appearing personally and who is known to me to be the same person who
executed this affidavit.

WITNESS MY HAND AND SEAL.

ATTY. JOONEE RANDYL E. RIVERA

Notary Public until December 31, 2018
Doc. No.: ; Aspiras Highway, Francia Sur, Tubao, La Union
Page No.: ; Roll No. 61766, TIN 929-347-628
Book No.: ; PTR No. 1470534; 01-03-17, Tubao, LU
Series of 2017. IBP Life Member No. 012553; 01-02-14, SFLU
Commission No. ANC-2016-30