REPUBLIC OF THE PHILIPPINES)

LAPU-LAPU CITY )


AFFIDAVIT OF ADJUDICATION BY SOLE HEIR
OF ESTATE OF _____decedents name______


I, ______affiants name________ , a Filipino citizen, of legal age,
single/married, and now residing at _____________________________, after
having been sworn to an oath in accordance with law, do hereby voluntarily
depose and say:


1. That I am the surviving spouse of deceased ____________________ who
died intestate in the City/Municipality of ___________________,
Philippines, as evidenced by Death Certificate issued by the
City/Municipal Civil Registrar of __________________ hereto attached as
ANNEX A and made an integral part of this Affidavit;

2. That said deceased left a conjugal estate consisting of a parcel of land
measuring TWO HUNDRED TWENTY POINT EIGHTY-FOUR (220.84)
SQUARE METERS located in the Municipality of
______________________, and evidenced by Tax Declaration No.
_____________________of the City/Municipal Assessors of
_____________________ and more particularly described as follows, to
wit:

description of the property/ies.

3. That said deceased left no debts;

4. That pursuant to Rule 74, Sec. 1 of the Rules of Court, I hereby adjudicate
unto myself the above described real estate by means of this Affidavit and
hereby files the same with the Register of Deeds and City/Municipal
Assessors of ____________________ with the request that said
adjudication be made effective without judicial proceedings as prescribed
by the aforementioned Rules of Court.

IN WITNESS WHEREOF, I have hereunto set my hand this
_______________________, in the _______________________.



________________________
Affiant

SUBSCRIBED AND SWORN to before me, in ___________________ this
_______________________, affiant exhibiting to me his/her valid Identification card
bearing number ________________, issued on ___________________ at
______________________.