TO : THE REGISTRY OF DEEDS

For the Province

of Agusan del Norte

ADVERSE CLAIM
On that parcel of land covered
by OCT no. P-4, 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”

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. In order to protect my and my co-heirs’

interest, I deem it necessary to interpose
this adverse claim of ownership over 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.

7. I respectfully request the Registry of

Deeds of Agusan del Norte to register the
foregoing adverse claim in its registry and
to annotate the same in OCT no. P-4.
 8. I hereby authorize my husband, PEPITO M.
BOLLOZOS, to act on my behalf and do all
acts necessary in connection with this
adverse claim, in my absence.

9. 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.