Republic of the Philippines )

Province of Leyte ) S. S.
Municipality of Tanauan )

AFFIDAVIT OF QUIT CLAIM AND RELEASE

I, CHONA R. MAGAYONES, of legal age, Filipino, and a resident of Brgy. ADA, Tanauan, Leyte, after
having been sworn according to law, hereby depose and state, THAT-

1. I am the legal heir of the late BALBINO O. MAGAYONES, that registered owner of a parcel of land
situated at Brgy.ADA, Tanauan, Leyte, particularly described as follows:
2.
“A parcel of land located at ___________, Tanauan, Leyte under Tax Declaration No. __________, Lot
No. ________, OCT/TCT No. P-____________, with an are of _______ha. More or less, bounded on the
North by Cad. Lot No. ________, East by Cad. Lot No. _____, South by Cad Lot No. ________ and on
the West by Cad Lot No. __________”;

3. I have been apprised by the Local Government thru the Punong Barangay of Barangay _____, Tanauan,
Leyte, Hon. _________________, of the implementation of an LGU-led subproject of the barangay
which is the construction of pathway projects under the 20% BDF and AIP;

4. I am fully aware and understand that the premises identified for the construction of the said pathway
project will party within my property at approximately 1meter in width and _________ meters in
length;

5. 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;

6. 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 ________________ at Tanauan, Leyte,
Philippines.

CHONA R. MAGAYONES
Affiant

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

Doc. No. _______

Page No._______
Book No._______
Series of 20_____