REPUBLIC OF THE PHILIPPINES)

PROVINCE OF ALBAY ) S.S.

TABACO CITY )
x------------------------------------------x

AFFIDAVIT OF SELF-ADJUDICATION

I, _________________, of legal age, single/married/widow, Filipino citizen, and

presently residing at _____________________, after having been duly sworn to in
accordance with law, do hereby depose and say:
1. That I am the only daughter of JUAN B. DELA CRUZ who died without any last
will and testament on July 20, 2013 in Makati City as evidenced by his Death
Certificate issued by the City of Makati hereto attached as Annex “A” and made an
integral part of this Affidavit;
2. That at the time his death, my father had no debts, liabilities or obligations to any
persons, agency or institution;
3. That the only property he left is a parcel of land consisting of 60 square meters
located in J.B. Roxas Street, Makati City more particularly described in TCT No.
112233 hereto attached as Annex “B” and made an integral part of this Affidavit;
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 Makati City with the request that the
said adjudication be made effective without judicial proceeding as prescribed by the
aforementioned provision of the Rules of Court.

IN WITNESS WHEREOF, I have hereunto set my hand this ____ day of ___________
20____ in ____________, _____________, Philippines.

___________________________________

Affiant

SUBSCRIBED AND SWORN TO before me this _____ day of _________ at

________________ affiant exhibited to his/her competent evidence of identity by way of
_________________ issued on __________________ in _______________,
Philippines.

ATTY. ANTHONY CLARK A. GAPIDO

Notary Public Tabaco City
For the Province of Albay
Roll No. 83746
IBP OR No. 227570; June 13, 2022
PTR No. 8843533; July 13, 2022 at Tabaco City
MCLE: N/A (Newly Admitted to the Bar)
2nd Floor Coastal Building Rental, Purok 2,
Morales Street, San Roque,Tabaco City, 4511

Doc No.____;
Page No. 450;
Book No. 35 ;
Series of 2022