Republic of the Philippines)

City of Santa Rosa)

Province of Laguna) S.S.

AFFIDAVIT OF SELF-ADJUDICATION

I, CRISANTA GARCIA URTOLA, of legal age, a widow, a Filipino, a resident of JB

Village, Brgy. Balibago, Santa Rosa City, Laguna, having been duly sworn to in accordance with
law, hereby state and depose:

1. That I am the only child of the late spouses EUSTAQUIO and ELENA GARCIA who
both died on the month of October 2010 without leaving any will and without any debts;

2. That my parents were the lawful and registered owners of a parcel of land covered by
Transfer Certificate of Title (TCT) No. T-460729 located at Brgy. Balibago, Santa Rosa City,
Laguna and with a land area of FOUR HUNDRED SIXTY EIGHT (468) SQUARE METERS
and hereunder specifically described:

Transfer Certificate of Title (TCT) No. T-460729

“A parcel of land (lot 1194-A-20 of the subd. Plan Psd-04-122522, being a

portion of Lot 1-94-A, Psd-04-007526 L.R.C. Rec. No. 8375) situated in the
Municpality of Santa Rosa, Province of Laguna, Island of Luzon xxx xxx xxx
xxx xxx containing an area of FOUR HUNDRED SIXTY EIGHT (468)
SQUARE METERS”

3. That being the only child of the late spouses EUSTAQUIO and ELENA GARCIA, I
now hereby adjudicate unto myself the above described and identified parcel of land pursuant to
Section 1 and Section 4, of Rule 74 of the Rules of Court (as amended) and consistent with
prevailing Philippine laws on succession and inheritance;

4. That I hereby attest to the truth and veracity of the foregoing narration of facts.

IN WITNESS WHEREOF, I hereunder set my hand this November 7, 2018 at Santa

Rosa City, Laguna.

CRISANTA GARCIA URTOLA

Affiant
OSCA ID No. 028029/SRL/05-07-2014

SUBSCRIBED AND SWORN TO BEFORE ME this November 7, 2018 at Santa

Rosa City, Laguna. Affiant exhibited too me her competent proof of identification indicated
below her name and signature.

Doc. No.: _____;

Page No.: _____;
Book No.: _____;
Series of 2018