Republic of the Philippines )

Province of Quezon ) S.S.

Municipality of Patnanungan )

AFFIDAVIT OF LOT OWNER’S CONSENT

I, _________________________________________ of legal age, Filipino, married, and a

resident of ________________________________, after having been duly sworn in accordance
with law, hereby depose and state:

1. That I am ____________________________________________________________
of the lot covered by Tax Declaration No.____________, Lot No._____Block No. ___
Survey No. Pls._____located in ______________________________.

2. That __________________________of___________________Patnanungan, Quezon

(Name of Lot Occupant) (Address of Lot Occupant)had built a
housein the said lot since __________;
(Year)

3. That I have no objections and am giving my full consent in such Electrical Permit in
my lot and giving her/him right to get a Municipal copy of Tax Declaration of my lot
for Electrical Permit:

4. That I am executing this affidavit to declare the truth of the foregoing facts and for
whatever legal purpose it may serve.

IN WITNESS WHEREOF, we have hereunto set our hands this __________________________ at

(Date)
__________________________________________, Philippines.
(Place)

______________________________________
Name of Affiant
Identification No._________

__________________________________ __________________________________
Witness Witness
I.D No._____________ I.D No.___________

Republic of the Philippines )

Patnanungan, Quezon ) s.s.

SUBSCRIBED AND SWORN to before me this _______ day of ____________, 2023

affiant exhibiting to me his/her Community Tax Certificate No.__________________ issued at
Patnanungan, Quezon on _______________________________________.

______________________________
NOTARY PUBLIC