REPUBLIC OF THE PHILIPPINES)

CAGAYAN DE ORO CITY ) S.S.

SWORN STATEMENT OF AUTHORIZATION

I, MARIETA I. URGENA, of legal age, married, Filipino and a resident of

#77 J. Ramonal Street, Brgy 29, Cagayan de Oro City, after being duly sworn to an
oath according to law, hereby depose and say: That -

1. I am the lawfully wedded wife of SIMEON B. URGENA, the tax declared

owner of a parcel of residential lot that is covered by Tax Declaration No. G-071995,
containing an area of about 901 Sq. M., more or less, situated in Kolambog,
Lapasan, Cagayan de Oro City and which is covered by TCT No. T-169893;

2. The foregoing residential lot is adjacent to another residential lot

containing an area of 64 Sq. M., more or less, tax declared in our names as lawfully
wedded spouses under Tax Declaration No. G-213092 and embraced in TCT No. T-
197870;

3. Pursuant to a Building Permit duly issued by the Office of the Building

Official of the City of Cagayan de Oro, a staff house is now undergoing construction
on the parcel covered by Tax Declaration No. G-213092 and TCT No. T-197870. The
exigencies of the times, however, have constrained us to convert said staff house,
before it is finished, into a regular residential house;

4. In view of the foregoing, there might be a need for the City Assessor’s
Office to assess anew the said on-going construction. If such is necessary, I hereby,
by these presents, give the City Assessor’s Office the authority to do so consistent
with what is right and proper; and

5. I executed this affidavit to be fully compliant with applicable implementing

rules and regulations relative the aforesaid on-going construction.

IN WITNESS WHEREOF, I have hereunto set my hand on this 26 th day of

May 2020, at Cagayan de Oro City, Philippines.

MARIETA I. URGENA
(Affiant)

SUBSCRIBED AND SWORN to before me this 26th day of May 2020, at

Cagayan de Oro City; Affiant exhibiting to me her Senior Citizen I.D. No. 69284,
issued on October 2019, by City Mayor Oscar S. Moreno.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2020.