AFFIDAVIT OF SELF-ADJUDICATION

REPUBLIC OF THE PHILIPPINES )

PROVINCE OF.................. ) SS.
MUNICIPALITY OF.............)
AFFIDAVIT
I, .................................................................. of legal age, single/married
to ..................................................... with residence and post-office address
at .............................. after having been duly sworn on oath in accordance with law,
hereby
depose and say:
I--That I am the only son and sole heir of one........ who died intestate on ............
at ................
2--That said deceased left a parcel of land located at ......................... consisting
of................................ square meters more or less, and more particularly described as
follows:
(DESCRIPTION)
3--That the decedent left no debts, nor any LAST WILL or TESTAMENT;
4--That pursuant to Sec. I of Rule 74 of the revised Rules of Court of the Philippines, I
hereby adjudicate unto myself the parcel of land above-described, and I hereby request
the Register of Deeds of ................................................ to register and render the same
effective.
5--That the above realty does not come under the operation of the Land Reform Code.
IN WITNESS WHEREOF, I have hereunder signed my name this .... day
of ..................................19..;at............................
WITNESS:
.....................................................
.........................
(JURAT,)