AFFIDAVIT OF SELF-ADJUDICATION BY SOLE HEIR

REPUBLIC OF THE PHILIPPINES)

CITY OF ILOILO …………………) S.S.

I, NAME, Filipino, of legal age, single and now residing at address at

Democracia St., Brgy. Ma. Cristina, Jaro, Iloilo City, Philippines, after
having been sworn in accordance with law, depose and say:

1. That I am the surviving daughter of CHRIS EVANNS who died

intestate in the City of Iloilo, Philipppines on March 01, 2018, as
evidenced by Death Certificate issued by the Office Civil Registrar,
Iloilo City hereto attached as Annex “A” and made integral part of
this Affidavit;

2. That said deceased left an estate consisting of a parcel of land

measuring TWO HUNDRED FORTY FIVE (245) SQUARE
METERS located in the City of Iloilo, and evidenced by Transfer of
Title No. T-83124 of the Registry of Deeds of Iloilo City;

3. That the said parcel of land is particularly described as follows:

TRANSFER CERTIFICATE OF TITLE No. T-83124 A parcel

of land ( Lot 2, Blk. 1, Pcs-131102-000284, being a portion of
consolidated Lots A-3-A (LRC), Psd-244362, Lot 1, (LRC) Psd-
70552, Lots 4-A-4-H & 4-C (LRC) Psd-80889, Lot 42-A, 42-B,
(LRC) Psd-12541, Lot 4& 2 (LRC) Pcs-3201, Lot 3-C-3, Psd-CAR-
000031; Lot 8, (LRC) Psd-30671, Lots 3-C-1-A & 3-C-1-B, Psd-
CAR-000435, Lot 3-C, Psd-1-008349, Lot 3-C-4, Psd-CAR-000051
& Lot 3-C-2-C, Psd-CAR- 000434), situated at Res. Sec. “J”, City of
Iloilo, Island of Panay. All points referred to are indicated on the plan
and are marked on the ground by PS cycl. Conc. mons. 15x40 cms.
Bearings true; date of original; survey on ; date of consolidation-subd.
survey on June 30, 2016, executed by Engr. Rodolfo S. Maningo Sr.
and was approved on April 17, 2017.

4. That the deceased left no debts;

5. That the net value of said estate is not more than three thousand pesos
(Php 3, 000), and is therefore exempt from the estate and inheritance
taxes, as evidenced by a certificate of exemption issued by the Bureau
of Internal Revenue hereto attached as Annex “B” and made an
integral part of this affidavit;
 6. That pursuant to Rule 74, Sec. 1 of the Rules of Court, I hereby
adjudicate unto myself the above-described real estate by means of
this Affidavit and hereby files the same with the Register of Deeds for
the City of Iloilo, with the request that said adjudication be made
effective without judicial proceedings as prescribed by the
aforementioned Rules of Court;

IN WITNESS WHEREOF, I have set my hand this 8th day of July, 2018 in
the City of Iloilo, Philippines.

NAME
Affiant

SUBCRIBED and sworn to before me, this 8th day of July, 2018 in
the City of Iloilo by NAME with Passport Number 454263877 issued
December 17, 2017 at DFA Iloilo.

Doc. No. _____; Commission Serial No. ____

Page No. _____; Until December 31, ___
Book No. ___; Roll of Attorneys ____
Series of 20__. IBP O.R. No. ___/ _____
PTR O.R. No. ____/ ____
MCLE Certificate of Compliance
No. ____

NOTARY PUBLIC