REPUBLIC OF THE PHILIPPINES ) : S.S.

CITY OF DAVAO : X ----------------------------------------- X

AFFIDAVIT
I, ___________________ of legal age, Filipino, married and a resident of _____________. ______________ , after having been duly sworn to hereby depose and say;

That I am the owner of a parcel of land, ________________________________________________ square meters, more or less;

known

as

That I hired the services of Geodetic Engineer Ruelin E. Tatad to cause the conduct of the subdivision survey of said ________________ in to seven ( 7 ) lots;

That the subdivision survey in not intended for housing project purposes pursuant to PD 957; That I am executing this foregoing affidavit to attest to the truth of the foregoing facts.

IN WITNESS WHEREOF, I have hereunto set my hand and affix my signature this _____th day of ______________________________ at Davao City, Philippines.

___________________ Affiant

SUBSCRIBED AND SWORN to before me this _____day of ____________________ at _________________, Philippines, affiant exhibited to me his Community Tax Certificate No. _______________ Issued on __________________________ at _______________________, Philippines.

Doc. No. Page No. Book No. Series of 2014