Republic of the Philippines. . .

)
Province of Negros Oriental. .)
City of Dumaguete. . . . . . . . . )

AFFIDAVIT OF HEIRSHIP
(RE: APPLICATION FOR WATER CONNECTION)

I, JOSE MAGNUS SOMONTAN LAZARTE BOLODO, of legal age,

Filipino, married and a resident of South Bagacay, Dumaguete City, Philippines,
having been duly sworn in accordance with the, hereby depose and state that:

1. I am one of the heirs of the lot situated in the barangay of ____, Dumaguete
City, Negros Oriental, known as Lot ____, covered by Tax Declaration No. .
Attached hereto is the copy of the land title;

2. The registered owner of the property, who is ___________, is my deceased

grandfather. Attached hereto is the copy of the death certificate of my
grandfather to prove such fact;

3. I would like to request the Metro Dumaguete Water for the approval of my
application for water connection which all the necessary expenses shall be
shouldered by me in line with the said connection;

4. I am executing this affidavit to attest to the truth of all the foregoing facts, to
support my request with the Metro Dumaguete Water for a new connection
and for all legal intents and purposes it may serve.

IN WITNESS WHEREOF, I have hereunto set my hands this 11th day of

April 2023, in Dumaguete City, Philippines.

JOSE MAGNUS SOMONTAN L. BOLODO

Affiant
Type of ID: Driver’s License
ID No.: G02-17-004862
Expiration Date: May 18, 2032
 SUBSCRIBED AND SWORN to before me this 11th day of April 2023, in
Dumaguete City, Philippines, affiant exhibiting to me his valid I.D. indicated
below his name, as competent evidence of identity.

Doc. No. ______;

Page No. ______;
Book No. _____;
Series of 2023.