(Declaration of Heirship / Self-Adjudication of Estate of Deceased Person)

REPUBLIC OF THE PHILIPPINES)

Province of Benguet) S.S.
City/Municipality of Baguio)
x - - - - - - - - - - - - - - - - - - - - - - - x

AFFIDAVIT

I, Samantha Co, Filipino, of legal age, single , and a resident of 7 Bokawkan Road, Baguo City,
Philippines, after being sworn in accordance with law, depose and state:

1. That I am the only child and sole heir of Peter Co who died intestate on January 1,
2013 at _____________;

2. That said deceased left a certain parcel of land covered by Transfer Certificate of
Title No. 12223 and more particularly described as follows:

(Technical Description of Property)

3. That said deceased left no debts, nor any Last Will and Testament;

4. That pursuant to Sec. 1 of Rule 74 of the Revised Rules of Court of the Philippines, I
hereby adjudicate unto myself the above-described parcel of land, and the
improvements found and standing thereon, and I hereby request the Register of Deeds
to issue a new Transfer Certificate of Title in my name;

5. That the above-described parcel of land does not come under the operation of the
Comprehensive Agrarian Reform Program.

IN WITNESS WHEREOF, I have hereunto set my hand this _____________ in
_____________, Philippines.


AFFIANT



SUBSCRIBED AND SWORN to before me, this _____________, by the Affiant who is
personally known to me (or whom I have identified through competent evidence of identity) and
who exhibited his/her Community Tax Certificate No. _____________ issued at _____________
on _____________.


NOTARY PUBLIC



Doc. No. ______;
Page No. ______;
Book No.______;
Series of 20____.

Affidavit of Self Adjudication
REPUBLIC OF THE PHILIPPINES)
CITY OF CEBU...........................)S.S.
AFFIDAVIT OF SELF- ADJUDICATION

I, (name) , Filipino, of legal age, (single/married), and a resident of (address)
, Cebu City, Philippines after having been duly sworn to in accordance with law, do hereby
depose and state, THAT:

1. I am the sole heir of the late (name of decedent) being his/her only
biological son/daughter;

2. The late (name of decedent) passed away on (date of death)
and died without any last will and testament;

3. At the time of death my father/mother had no debts, liabilities or obligations to any persons,
agency or institution;

4. The only property left by my late mother is (name and description of the property);

5. As sole heir of the herein decedent, I hereby adjudicate the abovementioned property solely
for and in my name as well as any and all liabilities arising from the said property;

6. I hereby execute this affidavit for the purpose of processing the transfer of the said property in
my name, the settlement of the estate of the late (name of decedent) , as well as
for the release of any other claim or benefit in relation to his/her death before any
government/private office and banking institution and for any other legal purpose this may best
serve.

IN WITNESS WHEREOF, I hereby set my hands this (date) at Cebu City,
Philippines.

(name of affiant)
Affiant

SUBSCRIBED AND SWORN to before me this (date) at Cebu City,
Philippines. Affiant exhibited to me his (I.D. and I.D. No.) issued
on _________________ at ______________ as his competent evidence of identity.

Doc. No.______;
Page No.______; (NOTARY PUBLIC)
Book No._____;
Series of 20____.