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That I, ANASTACIO CRISOSTOMO, of legal age, Filipino, married to FELIZA

TAGARIAN and resident of Barangay San Ignacio, San Mateo, Isabela, after being having been
duly sworn on oath in accordance with law hereby voluntarily depose and say:
That I am the registered owner of a parcel of land situated in the barrio of Barangay San
Ignacio, San Mateo, Isabela. As evidence by TCT . No. T-44570, issued by the Register of Deeds
of Isabela, containing an area of (3,766), SQAURE METERS, more or less:
That quite of accident, on the ____ th day of _______, _____, more or less, my envelop
(folder) fell from my hand while I was on my way to Santiago City. That noted the loss only
when upon reaching my destination, I saw that folder was gone, together with my TITLE TCT.
No. T-44570 but to no avail;
That I am executing this affidavit to attest to all the above facts, and to request the
Honorable REGISTER OF DEEDS of Isabela to issue the new owners duplicate of Title No.
TCT. No. T-44570;
IN TRUTH WHEREOF, I have here unto set my hand this ____________th day of
_____________________, _______________ at San Mateo, Isabela.

Issued at __________________
On __________________, 2013
SUBSCRIBED AND SWORN to before me this __________th day of
__________________, _____________ Affiant, who exhibited to me his ____________
indicated below the name and signature issued at ____________________.

Doc. No. _______________;

Page No. _______________;
Book No. ______________;
Series of 2013;