Republic of the Philippines )

Province of Davao del Norte )s.s.

City of Tagum )

AFFIDAVIT OF SELF ADJUDICATION BY SOLE HEIR OF ESTATE OF A DECEASED PERSON

I, CHITA B. TAGAOD, of legal age, Filipino citizen, single, and with residence at Apokon,
Tagum City, Davao del Norte, Philippines, after having been duly sworn to in accordance with
law, hereby depose and state:

1. That I am the surviving sister and only sole heir of the late RUBEN TAGAOD there being
no other ascendants, or descendants surviving, who died on May 24, 2009 in Apokon,
Tagum City, Davao del Norte, leaving without any will and any debt that has not been
settled up to the present;
2. That the deceased at the time of his death, left a certain property, containing an area of
872 square meters, more or less, situated at Barrio Apokon, City of Tagum, Province of
Davao del Norte, and particularly described hereunder:
TRANSFER CERTIFICATE OF TITLE No. T-229930

A parcel of land (Lot 592-J-2-C, Psd-11-095255, Amd.) being a portion

592-J-2, Psd-11-076184, situated in the Barrio of Apokon, City of Tagum, Province
of Davao del Norte, Island of Mindanao. x x x x x x x

Thence……
xxxxxx

Containing an area of EIGHT HUNDRED SEVENTY TWO (872) square

meters, more or less.

xxxxxx

That pursuant to Sec. 1 Rule 74 of the Revised Rules of Court of the Philippines, I hereby
adjudicate unto myself the above described parcel of land by means of this Affidavit without
judicial proceedings as prescribed by the aforementioned provision of theRules of Court.

I am executing this instrument, to attest to the foregoing facts and circumstances and
for all legal intents and purposes it may serve.

IN WITNESS WHEREOF, we have hereunto set our hands this __th day of
_______________, 2018 at Tagum City, Davao del Norte.

CHITA B. TAGAOD
Affiant
____________________

SUBCRIBED AND SWORN TO before me this __ day of _______ 2018 in Tagum City,
Davao del Norte, Philippines, affiant exhibiting to me her _____________________ issued in
_________ on ____________ and valid until ___________.

Doc. No. _____;

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

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