REPUBLIC OF THE PHILIPPINES)

Ormoc City ) S.S.

AFFIDAVIT TO RECOVERY OF LOST TITLE

I, JAIME COSTAÑOS COLTANA, of legal age, Filipino citizen, married, with

residence and postal address at Brgy. Sumangga, Ormoc City, after having been sworn to in
accordance with law, do hereby depose and state the following:

1. I am the registered owner of a parcel of land situated in Brgy. Patag, Ormoc City
contained in TCT No. 1171, more particularly described as follows:

TRANSFER CERTIFICATE OF TITLE NO. 1171

"A parcel of land (Lot 5 of the consolidation-subdivision plan (LRC) Pcs-18252, being a
portion of the consolidation of Lots 3410, 3411 & 3414, Ormoc Cadastre, L.R.C. Cad. Record
No. 1656), situated in the barrio of Patag (now Brgy. Patag), City of Ormoc, Island of Leyte.
Bounded on xxxxx Beginning; containing an area of FIFTEEN THOUSAND THREE HUNDRED
THIRTY EIGHT (15,338) SQUARE METERS, more or less.”

2. That on May 23, 2016, a certain Jonathan C. Ayon executed an Affidavit of Loss in
relation to TCT No. 1171 before the notarial registry of Atty. Daniel E. Pen, with Doc.
No. 230; Page No. 47; Book No. 31; Series of 2016;

3. Said Affidavit of Loss was annotated in the record of the said title in the Registry of
Deeds of Ormoc City under Entry No. 2016000011;

4. That it was just recently that I discovered that said title was declared lost by said Jonathan
C. Ayon when I secured the authenticated copy of the aforementioned title before the
Registry of Deeds of Ormoc City;

5. That said title had not been lost but was merely in my possession;

6. I hereby certify that the statements made herein are true and correct to the best of my
knowledge and belief;

7. I executed this Affidavit to attest to the truthfulness of the contents of this document and
for the purpose of requesting the Office of the Registry of Deeds of Ormoc City to
annotate this Affidavit.

IN WITNESS WHEREOF, I have hereunto affixed my signature this

____________________ in Ormoc City, Philippines.

JAIME COSTAÑOS COLTANA

Affiant

SUBSCRIBED AND SWORN to before me, this __________ in Ormoc City, affiant
exhibiting to me his SSS ID No. 06-0738712-6.

Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2022.