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WITNESSETH, THAT:
WHEREAS:
1. We are the sole heirs of the deceased XYZ, who died on May 17,
2014, at Brokenshire Hospital; A copy of her death certificate is
hereto attached as ANNEX B;
2. The deceased XYZ died intestate, without Will or Testament, and
without any outstanding debts in favor of any person or entity;
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_____________________________
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ACKNOWLEDGMENT
BEFORE ME, a Notary Public for and in Davao City, Philippines personally
appeared:
NAME
ID NUMBER
DATE ISSUED
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