FORM NO. 1.

AFFIDAVIT OF ADJUDICATION OF ESTATE

OF A DECEASED PERSON

REPUBLIC OF THE PHILIPPINES)

CITY OF BAGUIO ) S.S.

AFFIDAVIT OF ADJUDICATION OF ESTATE OF A

DECEASED PERSON

I, ELLEN B. ADARNA, of legal age, Filipino, single,

with residence and postal address at #9 Cabinet Hill, Purok
3 Leonard Wood Road, Baguio City, after having been duly
sworn to in accordance with law, hereby say:

That I am the only daughter of PEAN D. ADARNA who

died intestate on December, 17, 2016 in Baguio City.

That at the time his death, my father had no debts,

liabilities or obligations to any persons, agency or institution;

That my father left a parcel of residential land that is

particularly described and bounded as follows:

A parcel of residential land situated at Pinsao, Proper,

Baguio, City containing an area of twenty thousand and sixty
eight (20,068) square meters, more or less; bounded on the
north by James King; on the east by Tanco; on the south by
Barra; and on the west by Ana; covered by Tax Declaration
No. 27-0124-00817 of the Assessors Office of Baguio, City
with an assessed value of P90, 650.00

That pursuant to Rule 74, Sec. 1 of the Rules of Court, I

hereby adjudicate unto myself the above-described
residential land by means of this Affidavit and hereby files
the same with the Register of Deeds of Baguio, City with the
request that the said adjudication be made effective
without judicial proceeding as prescribed by the provision of
the Rules of Court.

IN WITNESS WHEREOF, I have hereunto set my hand,

this 16th day of January, 2016 at Baguio City, Philippines.

ELLEN B. ADARNA

Affiant

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 SUBSCRIBED AND SWORN to before me, this 16th day
of January, 2017 in Baguio City, Philippines, affiant exhibiting
to me her drivers license no. L02-10-033467, valid until
January 27, 2020, issued at Baguio City.

Doc. No. _1___;

Page No. _2___;
Book No. _1___;
Series of 2017.

Notarial Register

Of

ATTY. DENVER A.
GAMLOSEN

Notarial Commission Reg. No.

105

Valid until Dec. 31, 2017

Roll No. 0008

P.T.R. No. 0007, 1/4/2017,

Baguio.

IBP No. 0003, 1/9/2017,

Baguio.

MCLE Compliance No. 1234

2 | Page
FORM NO. 2. AFFIDAVIT OF CONSENT
FOR TRAVEL OF A MINOR ABROAD

REPUBLIC OF THE PHILIPPINES)

CITY OF BAGUIO ) S.S.

AFFIDAVIT OF CONSENT FOR TRAVEL OF A MINOR

ABROAD

We, BROD Q. PIT and ANGELINA G. JOLIE, of legal ages,

married, Filipinos, and residents of #55 Km. 86, Marcos hi-
way, Baguio, City, Philippines, with residential telephone
no.886-875-987and with Tax Identification Nos. (T.I.N.) 134-
798 and 879-655, respectively, after having been duly sworn
in accordance with law, hereby state:

That we are the parents of Vangie J. Pit who is a minor

and a citizen of the Republic of the Philippines and a
holder of valid Philippine Passport with No. 345-67 and who

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is going for a trip abroad specifically to Russia this February
14, 2017;

That we are giving our full consent to our said daughter

to travel abroad or specifically to Russia;

That for this purpose, we have sufficient and adequate

financial capacity to support and defray the travel and
hereby undertake to finance her trip abroad from the
application fees, airline tickets, board and lodging, pocket
money and other expenses that she may incur during her
trip abroad;

That there is no criminal case pending in court against

her nor has she been charged of subversion, rebellion,
insurrection or any crime or offense involving moral
turpitude in any court of the Philippines;

That further, Vangie J. Pit will be accompanied or

escorted by her teacher, Madonna A. Kimson in her travel
abroad;

That we are hereby giving our full consent to teacher

Madonna to accompany or escort Vangie in her travel
abroad;

That we are executing this affidavit to declare the

truth of the foregoing facts and for whatever legal purpose it
may serve.

IN WITNESS WHEREOF, we have hereunto set our hands

this January 16, 2017 at Baguio City, Philippines.

BROD Q. PIT and ANGELINA G. JOLIE

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affiants

SUBSCRIBED AND SWORN to before me, this 16th day

of January, 2017 in Baguio City, Philippines, the affiants
exhibiting to me their tax identification card with nos. (T.I.N.)
134-798 and 879-655, issued at Baguio City.

Doc. No. _2___;

Page No. _2___;
Book No. _2___;
Series of 2017.

Notarial Register

Of

ATTY. DENVER A.
GAMLOSEN

Notarial Commission Reg. No.

105

Valid until Dec. 31, 2017

Roll No. 0008

P.T.R. No. 0007, 1/4/2017,

Baguio.

IBP No. 0003, 1/9/2017,

Baguio.

MCLE Compliance No. 1234

2 | Page
FORM NO. 3. AFFIDAVIT OF CONSOLIDATION
OF OWNERSHIP IN PACTO DE RETRO SALE

REPUBLIC OF THE PHILIPPINES)

CITY OF BAGUIO ) S.S.

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 AFFIDAVIT OF CONSOLIDATION OF OWNERSHIP IN
PACTO DE RETRO SALE

I, FAITH G. HILL, of legal age, Filipino, single and a

resident of #2223 Don Bosco Street, Trancoville, Baguio City,
after having been duly sworn to in accordance with law,
hereby say:

1. That on November 20, 2014, Mr. George B. Strait,

of legal age, Filipino, single, residing at #67 Tam-awan,
Pinsao proper, Baguio City, sold to me a certain parcel
of land under pacto de retro, executed before Notarial
Public John D. Legend and bearing Not. Reg. No. 56,
Page 7, Book II, Series of 2014 of his Notarial Register
(copy of the pacto de retro sale is hereto attached as ANNEX
A);

2. That pursuant to the deed of sale with pacto de retro,

Mr. George B. Strait, should have exercised his right to
repurchase the land within the period of two (2) years;

3. That the period expired on November 20, 2016

without George B. Strait, by himself or by any other
person in his behalf complying with the condition and
stipulation required for the repurchase of the property;

4. That the period of repurchase has not

been extended, either expressly or impliedly, by affiant
vendee a retro;

5. That by virtue of the deed of sale with pacto de

retro, and the failure of the vendor, Mr. George B.
Strait, to duly repurchase the property within the
period stipulated, there was consolidated in the affiant,

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 as vendee a retro, the absolute ownership of the
property. Attached hereto, as ANNEX B, is an order of
the Regional Trial Court of Baguio City issued on
December 27, 2016, approving and confirming the
above consolidation of ownership in the name of affiant.

IN WITNESS WHEREOF, I have hereunto set my hand

this 16th day of January 2017 at Baguio City, Philippines.

FAITH G. HILL

Affiant

SUBCRIBED AND SWORN TO before me this 16th day of

January 2017 in Baguio City, Philippines, affiant exhibiting to
me her Philippine Passport No. 123456 issued in Manila on
January 12, 2016 and valid until January 12, 2019.

Doc. No. _4___;

Page No. _2___;

Book No. __6__;

Series of 2017.

Notarial Register

Of

ATTY. DENVER A.
GAMLOSEN

Notarial Commission Reg. No.

105

Valid until Dec. 31, 2017

Roll No. 0008

2 | Page
 P.T.R. No. 0007, 1/4/2017,
Baguio.

IBP No. 0003, 1/9/2017,

Baguio.

MCLE Compliance No. 1234

2 | Page
FORM NO. 4. AFFIDAVIT OF DESISTANCE

REPUBLIC OF THE PHILIPPINES)

CITY OF BAGUIO ) S.S.

AFFIDAVIT OF DESISTANCE

I, KISTINE T. HERMOSA, of legal age, Filipino, single, and

a resident of #32 Lourdes subdivision, Baguio City,
Philippines, after having been duly sworn in accordance with
law, hereby depose and say:

That I am the private complainant in the criminal case

entitled "People of the Philippines vs. Jeicho Nosales y
Villion, Criminal Case No. 12-
200 pending before the Municipal Trial Court, La Trinidad,
Benguet, Philippines;

That after a thorough analysis of my memories of the

incident that occurred on January 16,
2016, I have realized that I cannot point out, beyond
reasonable doubt that the accused Jeicho Nosales y Villion,
committed the crime of theft on January 16, 2016, as it was
too dark to discern the features of the perpetrator with any
degree of certainty;

Since I could not state with certainty and without doubt

the liability of the accused
I feel compelled to withdraw my complaint against him and I
clear him of whatever responsibility or liability to me;

That I manifest to completely exonerate the accused

from any liability in connection with the criminal case and
that I am no longer interested, and I hereby desist, in
prosecuting the criminal case;

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 That I execute this Affidavit of Desistance so that
the criminal case be immediately dismissed and considered
finally closed and the bond posted by the accused be
released to him;

As such, I respectfully pray that the case against the

accused Jeicho Nosales y Villion, be dismissed and finally
closed.

IN WITNESS WHEREOF, I have hereunto set my hand

this 16th day of January 2017 at Baguio City, Philippines.

KISTINE T.
HERMOSA

Affiant

SUBCRIBED AND SWORN TO before me this 16th day of

January 2017 in Baguio City, Philippines, affiant exhibiting to
me her Philippine Passport No. 76543 issued in Manila on
June 20, 2015 and valid until June 20, 2018.

Doc. No. _3___;

Page No. _2___;

Book No. __7__;

Series of 2017.

Notarial Register

Of

2 | Page
 ATTY. DENVER A.
GAMLOSEN

Notarial Commission Reg. No.

105

Valid until Dec. 31, 2017

Roll No. 0008

P.T.R. No. 0007, 1/4/2017,

Baguio.

IBP No. 0003, 1/9/2017,

Baguio.

MCLE Compliance No. 1234

2 | Page
FORM NO. 5. AFFIDAVIT OF DISCREPANCY
(DATE OF BIRTH)

REPUBLIC OF THE PHILIPPINES)

CITY OF BAGUIO ) S.S.

AFFIDAVIT OF DISCREPANCY
I, JOSH B. TURNER, of legal age, single, Filipino and a
resident of #54 Youngstown subdivision, Baguio City,
Philippines, after having been duly sworn to in accordance
with law, hereby depose and state:
That in my Certificate of Live Birth as recorded
in the Office of the Civil Registrar of Baguio City, Philippines
and Secondary Student Permanent Record at Don Bosco,
High School, it is stated that I was born on 21 May 1974 at
Baguio General Hospital, Baguio City, Philippines;
That my relatives, acting on the honest belief that I was
born on 21 May 1971, had used 21 May 1975 as my birth
date in all pertinent school records when they processed my
enrollment at University of the Cordilleras in Baguio City;
That when I filled up my voter's registration record
required by the Commission on Election last May 7, 2016, I
had inadvertently and erroneously written the date of my
birth as 21 May 1975 instead of 21 May 1974;
That I am executing this Affidavit of Discrepancy to
attest to the truth of the foregoing facts and to explain the
discrepancy in my Certificates of Live Birth, Secondary
Student Permanent Record Transcript of Records and Voter
Registration Form as regards to my date of birth;
Further, I am declaring that from this date hereon I
would be using my true and correct date of birth of 21 May
1974 in all my papers, records and other documents.

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 IN WITNESS WHEREOF, I have hereunto set my hand
this 16th day of January 2017 at Baguio City, Philippines.

JOSH B.
TURNER

Affiant

SUBCRIBED AND SWORN TO before me this 16th day of

January 2017 in Baguio City, Philippines, affiant exhibiting to
me her Drivers license No. 98-09489-15 issued in Baguio,
expires on June 18, 2019.

Doc. No. _7 __ ;

Page No. _2___;

Book No. __5__;

Series of 2017.

Notarial Register

Of

ATTY. DENVER A.
GAMLOSEN

Notarial Commission Reg. No.

105

Valid until Dec. 31, 2017

Roll No. 0008

2 | Page
 P.T.R. No. 0007, 1/4/2017,
Baguio.

IBP No. 0003, 1/9/2017,

Baguio.

MCLE Compliance No. 1234

FORM NO. 6. AFFIDAVIT OF DISCREPANCY (DATE OF

MARRIAGE OF PARENTS)

REPUBLIC OF THE PHILIPPINES)

CITY OF BAGUIO ) S.S.

AFFIDAVIT OF DISCREPANCY

I, MIKO D. NAGKULANG, of legal age, Filipino, married,

and a resident of #34 Kitma Village, Baguio City, Philippines
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having been duly sworn in accordance with law, hereby
state:
That I was born to the spouses Alberto T. Nagkulang
and Trisha D. Nagkulang on December 18, 1990 in Sagpat
Kibungan, Benguet Province, Philippines as evidenced by the
Certificate of Live Birth issued by the Municipal Civil
Registrar of the Municipality of Kibungan;
That in the Certificate of Live Birth, the date of
marriage of my parents was erroneously written as "May
3,1960" instead of the true and correct date May 8, 1960" as
evidenced by the Certificate of Marriage of my parents
issued by the Municipal Civil Registrar of the Municipality of
Kibungan, hereto attached as Annex "A";
That the discrepancy in my Certificate of Live Birth was
an error done inadvertently;
That I execute this Affidavit of Discrepancy to attest to
the truth of the foregoing facts.

IN WITNESS WHEREOF, I have hereunto set my hand

this 16th day of January 2017 at Baguio City, Philippines.

MIKO D.
NAGKULANG

Affiant

SUBCRIBED AND SWORN TO before me this 16th day of

January 2017 in Baguio City, Philippines, affiant exhibiting to
me her Social Security Identification Card with no. 675438
issued at Baguio City.

2 | Page
Doc. No. _8___;

Page No. _2___;

Book No. __2__;

Series of 2017.

Notarial Register

Of

ATTY. DENVER A.
GAMLOSEN

Notarial Commission Reg. No.

105

Valid until Dec. 31, 2017

Roll No. 0008

P.T.R. No. 0007, 1/4/2017,

Baguio.

IBP No. 0003, 1/9/2017,

Baguio.

MCLE Compliance No. 1234

2 | Page
2 | Page
FORM NO. 12. AFFIDAVIT OF LOSS (CERTIFICATE OF
OWNERSHIP PAPERS OF AUTOMOBILE)

Affidavit of Loss of Certificate of Ownership Papers of

Automobile

REPUBLIC OF THE PHILIPPINES)

CITY OF BAGUIO ) S.S.

I, DUGONG O. DUTERTE, of legal age, married, residing at

#72, Marcos hi-way, Bakakeng Central, Baguio City, after
being sworn to in accordance with law, hereby say:

1. That I am the true owner of an automobile, described

as follows:

Make: Mitsubishi

Model: 2006

Chassis Serial No:

Plate No.: AHN 654

2. That the described automobile had been duly registered

in my name in the Land Transportation Office in Baguio
City for the years 2006 to 2016;

3. That the certificate of registration and other pertinent

papers of ownership of said automobile were among
those burned and destroyed on December, 22, 2016
when my garage where the automobile was parked and

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 all my personal belongings were completely destroyed
by fire;

4. That the papers of the automobile are now under

recovery.

IN WITNESS WHEREOF, I have hereunto set my hand

this 20th day of January 2017, in the City of Baguio,
Philippines.

Dugong O. Duterte

(Signature
of Affiant)

SUBCRIBED AND SWORN TO before me, this 16th day of

January 2017, in the City of Baguio, Philippines, by Dugong
O. Duterte exhibing to me his Phil Health Card with no.
675438 issued on January 19, 2016 at Baguio City.

ATTY. DENVER A.
GAMLOSEN
NOTAY PUBLIC
Commission Serial No. 105
Until December 31, 2017
Roll No. 0008
Doc. No. _8___; P.T.R. No. 0007, 1/4/2017,
Baguio.
Page No. _2___; IBP No. 0003, 1/9/2017,
Baguio.
2 | Page MCLE Compliance No. 1234
Book No. __2__;

Series of 2017.

NOTARY
PUBLIC
ROLL NO.

BAGUIO CITY,
PHILIPPINES

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