Republic of the Philippines)

______________) S.S

AFFIDAVIT OF LOSS
I, JANET D. GARCIA, of legal age, married to Jose Nestor M. Garcia,
Filipino citizen, with residence and postal address at No. 8 Robertson St.,
Greenview Executive Village, Sauyo, Novaliches, Quezon City, after having been
duly sworn to in accordance with law hereby depose and state:

1. That I am the registered owner of a parcel of land located at

Barrio Bagbag, Quezon City, containing an area of One
Hundred Eighty (180) square meters (sq.m). covered by Transfer
Certificate of Title No. 004-2014008115 (57413). Attached
hereto is the copy of the said Transfer Certificate of Title marked
as ANNEX A of this Affidavit;

2. I was not able to immediately effect the transfer of Tax

Declaration from the previous owners Sta. Lucia Realty in our
name because I was then preoccupied with my work at

3. the Department of Agriculture. Sometime in January 2017,

when I decided to process the transfer of Tax Declaration in our
name, because I finally had the time and opportunity to do so, I
discovered that the original duplicate copy of the Deed of Sale,
Transfer Tax Certificate and the BIR Certificate Authorizing
Registration were missing. I could no longer find it in my files.

4. All diligent efforts I exerted to locate and retrieve it were in vain,

hence for all legal intents and purposes the above-mentioned
documents were now deemed lost and beyond recovery.

5. I certify and confirm that the parcel of land covered by Transfer

Certificate of Title No. 004-2014008115 (57413). of the Registry
of Deeds of Quezon City was never mortgaged, sold, conveyed,
disposed of, or encumbered, to any other person or entity. I
certify and confirm further that the said documents were
neither confiscated nor relinquished in favor of any government
entity of authority.

6. I attest to the truth of foregoing statements to the best of my

own personal knowledge and based on authentic documents or
records. I am executing this Affidavit of Loss to support my

1
 application for Transfer of Tax Declaration as well as for all
lawful intents and purposes it may serve.

AFFIANT FURTHER SAYETH NAUGHT.

IN WITNESS WHEREOF, I have hereunto set my hand this _________________ in

_______________________, Philippines.

JANET D. GARCIA
Affiant

SUBSCRIBED AND SWORN to before me this ____________________,

affiant exhibited to me his/her Competent Evidence of Identity by way of his ID
DA ID. NO. 528 issued at _____________________________ on __________________.

Doc. No. ________

Page No. _______
Book No.________
Series of 2017.