Republic of the Philippines )

Province of Leyte ) S.S.

Municipality of Dagami )

AFFIDAVIT OF QUITCLAIM AND RELEASE

I, Maria Cleofe B. Dacuno , of legal age, Filipino, and a resident of Brgy. Lapu-Lapu Dist.2,
Dagami, Leyte, after having been sworn according to law, hereby depose and state, THAT –

1. I am the legal heir of the late Catalina Berino, the registered owner of a parcel of land situated
at Brgy. Lapu-Lapu Dist.2, Dagami, Leyte, particularly described as follows:

“ A parcel of land located at Brgy. Lapu-Lapu Dist 2, Dagami, Leyte under Tax Declaration No.
12001-00027, Lot No. 604 with an area of 265.65 sq.m ha. more or less, bounded on the North
by Cad. Lot No. 005,007/Lot No. 595,605 , East by Cad. Lot No. 007,003/Lot No. 605,608 South:
Cantosemiana Canal and on the West by Cad. Lot. No. 005,008,011,017/ Lot. No.
595,596,597,598.;

2. I have been apprised by the Local Government thru the Punong Barangay of Barangay Lapu-Lapu
Dist 2, Dagami, Leyte, Hon. Maria Cleofe B.Dacuno, of the implementation of an LGU-led
subproject of the barangay which is the construction of a Installation of Communication Devices
to Support Information Dissemination under the KALAHI-CIDSS Program;

3. I am fully aware and understand that the premises identified for the construction of the said
pathway project will partly lie within my property at approximately 0.7 sq. meters in width and
0.7 in length;

4. In view hereof, I hereby CONSENT to the construction of the said pathway within my property
and RELEASE the Local Government or any of its officers from any and all money claims or
otherwise due me incident to the implementation of the said project;

5. I hereby further state that I am executing this QUITCLAIM which shall be valid only for a period
of twenty-five (25) years and commit to protect and help in maintaining the sustainability of the
said project within the same period.

IN WITNESS WHEREOF, I have hereunto set my hand this 26th day of September at Dagami,
Leyte, Philippines.

Maria Cleofe B. Dacuno

Affiant

SUBSCRIBED AND SWORN to before ma this ____________ by ____________, who has satisfactorily
proven to me her identity through her/his ___________ issued on _________, that she is the same
person who personally signed before me the foregoing affidavit which she acknowledged that she
executed the same.

Doc. No. _______

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