REPUBLIC OF THE PHILIPPINES )

CITY ________________________) S.S.

AFFIDAVIT OF SELF-ADJUDICATION

That I, BRIGIDA M. MENDOZA, single, of legal age, Filipino and a resident of

Brgy. Ulango, Tanauan City, Batangas, hereby depose and state that:

 That I am the only surviving heir of the deceased TOMASA MAGLINAO

MENDOZA, who died instated at Brgy. Ulango, Tanauan City, Batangas on
October 3, 2005;

 That the said deceased left the following parcel of land which is particularly
described as follows;

TRANSFER CERTIFICATE OF TITLE NO. T-63385

A parcel of land (Lot No. 9913 of the Cadastral Survey of Tanauan), with the
improvements thereon, situated in the Municipality of Tanauan. Bounded on the NE., by
Lot No. 5937; on the SE., by Lot No. 5938; on the SW., by Lot No. 9914; and on the NW.,
by Lot No. 5936. Beginning at a point marked as “1” on plan x x x containing an area of
ONE THOUSAND EIGHT HUNDRED SEVENTY FOUR (1,874) square meters, more or
less.
 That in the remote event that any other property of the deceased should ever be
found which is not included herein above; I reserve the right to adjudicate to myself
such properties through a separate instrument.

WHEREFORE, and invoking the provisions of the Rule 74, Section 1, herself as
the heir of the entire insurance here above described including all existing improvements
thereon, subject only to the liabilities to creditors, heir and other persons who might have
been deprived of their lawful participation in the estate, for a period of two (2) years in
accordance with Rule 74, Section 4 of the Rules of Court.

That said parcel of land is not registered under Act No. 496 nor the Spanish
Mortgage Laws and we agree to register these land under Act No. 3344.

FURTHER AFFIANT SAYETH NONE.

IN WITNESS WHEREOF, I have hereunto set my hand this _____ day of

__________________ at _________________________.

BRIGIDA M. MENDOZA
Surviving Heir

WITNESSESS:

1.) __________________________ 2.) __________________________

 ACKNOWLEDGEMENT

REPUBLIC OF THE PHILIPPINES)

CITY OF ____________________) S.S.

BEFORE me, a Notary Public for and in the ____________________, personally

appeared BRIGIDA M. MENDOZA, this ______ day of _________________ affiant
exhibited to his valid Identification card No. ____________________, issued on/at
________________________.

I further certify that the foregoing instrument consisting of two (2) pages, including
this page where the acknowledgement is written and that both pages have been signed
by the parties and their instrumental witnesses.

IN WITNESS WHEREOF, I have hereunto set my hand and seal at the place and
on the date above-written.

Doc. No. ________;

Page No. ________;
Book No. ________;
Series of ________.