Republic of the Philippines )

Province of Leyte )
Municipality of Villaba ) S.S.
x----------------------------------x

AFFIDAVIT

I, URSULA CORTEN, of legal age, widow, Filipino and a resident of 87 Bunnet RD,
Knoxfield 3180 Victoria, Australia, after having been duly sworn to in accordance with law, do
hereby depose and state:

1. That I am the Buyer of a parcel of land known as Lot No. 551-C, Ass. Lot No. 008 with
Property Identification No. 044-41-001-04-008 under Tax Declaration 05-41001-00483, situated
at Brgy. Poblacion del Norte, Villaba, Leyte, containing an area of 3, 450 square meters, more or
less, as evidenced by a duly executed Deed of Absolute Sale dated January 15, 2018 entered in the
Notarial Registry of Atty. Chelissa Mae N. Rojas, CPA, as Doc No. 382; Page No. 78; Book No.
V, Series of 2018 (the, “Deed”);

2. That in said Deed, my civil status does not appear;

3. That I hereby execute this Affidavit to attest to the truth that my civil status, at the time I
executed said Deed and at present, is WIDOW;

4. That I bought the said parcel of land out of my own, personal and exclusive money;

5. That I have not entered into marriage with anyone since my husband died on May 28, 2016.

6. That this affidavit is being executed to attest to the foregoing facts for the specific purpose
of transferring said property to my name with the Office of the Registry of Deeds, Tacloban City,
Leyte.

IN WITNESS WHEREOF, I have hereunto set my hand this ____th day of __________,
2018 at _____________________ Philippines.

________________________
URSULA CORTEN
Affiant

SUBSCRIBED AND SWORN to before me, this _____th day of _______________ 2018 at
___________________, Philippines, by the Affiant who is personally known to me (or whom I have
identified through competent evidence of identity) and who exhibited her competent evidence of
identity with No. _______________ issued on _______________ at ______________________.

NOTARY PUBLIC
Doc. No. ______;
Page No. ______;
Book No.______;
Series of 2018.