REPUBLIC OF THE PHILIPPINES }

MAKATI CITY } S.S

DEED OF SELF ADJUDICATION

WITH ABOSOLUTE SALE

I, ___________, of legal age, Filipino citizen, single and resident of

_____________________, after having been duly sworn, to in accordance with law,
depose and states:

1. That I am the _________ and the only surviving heir of the late
______________;

2. That ___________, died on _____________ at __________; (Certificate of

Death of ___________ is herein attached as Annex “A”)

3. That at the time of the death of the deceased, he is the registered owner of
a parcel of land, covered by Transfer Certificate of Title No. _______ issued
by the Registry of Deeds for _____________ and more particularly described
as follows:

“A parcel of land situated at __________________,

containing an area of _________________, more or less;
bounded on the North by _________; on the East by
____________; on the South by ____________; and on
the West by ____________; covered by Tax Declaration
No. ____________ of the Assessor’s Office of
______________ with an assessed value of
______________”.

4. That at the time of her death, she left no debts, nor a last will and testament
and that there is no pending case or action filed against said property in any
Court of the Philippines.

5. Therefore, in view of all the foregoing and pursuant to the provisions of Sec 4
rule 74 of the Rules of Court of the Philippines, I hereby ADJUDICATE and by
 these presents has ADJUDICATED unto, myself the above -described parcel of
land.

6. That for and in consideration of the amount of

__________________________ Philippine currency, I received in full from
the BUYER: ____________________, of legal age ,Filipino citizen, single and
resident of ___________________

7. , I do hereby dispose sell and transfer & cede to her heirs assign the above-
described parcel of land, free form all liens and encumbrances

IN WITNESS WHEREOF, I have hereunto set my hand this ___ day of __________,
____ at _____________, Philippines.

_____________________ ______________________
Seller Buyer

WITH MARITAL CONSENT:

_____________________ ______________________
Seller’s Spouse Buyer’s Spouse

SIGNED IN THE PRESENCE OF:

_____________________ ______________________