REPUBLIC OF THE PHILIPPINES)

CITY OF BUTUAN ) S.S.

x---------------------------------------------x

AFFIDAVIT OF ADVERSE CLAIM

I, JORGE S. MEDINA, JR., Filipino, of legal age, and a resident of Brgy. Bonbon,
Butuan City, after having been duly sworn to in accordance with law, depose and state:

1. I am a recipient of a waiver of rights executed by Catalino S. Pangahin on

August 6, 1993 recorded as Document No. 1176, Page No. 3, Book No. 21
and Series of 1993 of the Notarial Book of Notary Public Ric Sarabosing, a
copy of which is hereto attached as Annex “A”;

2. In the said waiver of rights, Catalino S. Pangahin waived/relinquished his

right over two (2) parcels of land, Lot No. 2672-B-5 and Lot No. 2672-B-6 in
favor of the undersigned affiant;

3. The Tax Declaration of Real Property No. 08-07-0002-01579 and Tax

Declaration of Real Property No. 08-07-0002-01443 were correspondingly
issued covering Lot No. 2672-B-5 and Lot No. 2672-B-6, copies of tax
declarations are hereto attached as Annexes “B” and “C”;

4. Although undersigned affiant shouldered the payment of the real property

tax of the two lots since 1993, aforementioned tax declarations still indicate
Catalino S. Pangahin as an owner, copies of tax payments are here attached
as Annex “D” and series;

5. Further, undersigned affiant effected full payment of the land amortization

in Land Bank of the Philippines, please refer to the Certification issued by
the Land Bank of the Philippines hereto attached as Annex “E”;

6. I am therefore executing this Affidavit of Adverse Claim for the purpose of

attesting to the truthfulness of the foregoing facts and in support of my
request for the annotation of adverse claim in my person on Tax Declaration
of Real Property No. 08-07-0002-01579 and Tax Declaration of Real Property
No. 08-07-0002-01443.

IN WITNESS WHEREOF, I HAVE HEREUNTO set my hand this 13 th day of March 2023
at Butuan City, Philippines.

JORGE S. MEDINA, JR.

SUBCRIBED AND SWORN TO before me this 13 th day of March 2023 in Butuan City,
Philippines., affiants exhibiting to me their respective competent proof of identity.

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