AFFIDAVIT

REPUBLIC OF THE PHILIPPINES )

CITY OF ILOILO ) S.S.

I, Maria A. Santos, of legal age, single, and now residing at Jaro, Iloilo City,
Philippines, after having been sworn in accordance with law, depose and say:

1. That I am the only surviving daughter of Helen S. Santos, who died

intestate in the Municipality of Otom, Iloilo, Philippines on January 2, 2021, as
evidenced by Death Certificate issued by the Philippine Statistics Authority hereto
attached as Annex “A” and made an integral part of this Affidavit;
2. That the said deceased left an estate consisting of a parcel of land
measuring 100 sq.m. located in Iloilo municipality of Oton, and evidenced by
Transfer of Title No. L-4356 of the Registry of Deeds of Iloilo.
3. That the said parcel of land is more particularly described as follows:

A PARCEL OF LAND (Lot 20 Blk 54 of consolidation subdivision

plan (LRC) Pcs-13265, being a portion of the consolidation of Lots 4751-A
and 4751-B (LRC) Psd-50533, Lot 3, Psd-100703, Lot 1, Psd150980, LRC
Rec. Nos. Nos. N-27024, 51768, 89632, N-11782, N-13466, and 21071
situated in the, Mun of Oton, Prov of Iloilo. Bounded on NE., point 4 to 1 by
Road Lot 22, on...to the point of beginning; containing an area of (100)
square meters more or less..."

4. That the said deceased left no debts;

5. That the net value of said estate is not more than three thousand (3000) pesos,
and is therefore exempt from the estate and inheritance taxes, as evidenced by a
certificate of exemption issued by the Bureau of Internal Revenue hereto attached as
Annex “B” and made an integral part of this affidavit;
6. 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 Registry of Deeds of Iloilo with the request that said adjudication be made
effective without judicial proceedings as prescribed by the aforementioned Rules of
Court.

IN WITNESS WHEREOF, I have hereunto set my hand this 1st day of June, 2021, in the
Province of Antique, Philippines.

Maria A. Santos
(affiant)

SUBSCRIBED AND SWORN to before me this 1 st day of June, 2021 at San Jose,
Antique, Affiant exhibiting to me his Community Tax Certificate bearing No. 123456
issued at Hamtic, Antique on June 3, 2018.

Doc No. 3;
Page No. 1; Jean Jamailah Tomugdan
Book No. 4; (Notary Public)
Series of 2021.