AFFIDAVIT OF SURVIVORSHIP AND DECLARATION OF HEIRSHIP

KNOW ALL MEN BY THESE PRESENTS:

We, ____________, widow, and _________________, all of legal ages,
Filipinos and residents of ______________________ after having been duly
sworn to in accordance with law hereby depose and say:
That we are the sisters and
surviving heirs of the late Jose
__________________. That our parents are already deceased and our sister
______________
and
__________________
have
precedeceased
_______________ and without any surviving heirs.
That ________________ during his
lifetime
___________________with the following descriptions:

is

the

holder

of

FLA NO. ____________

Place: _________________
Issued on : August 15, 1978
Expiring on December 31, 2002
Area: 11,2040 hectares
FLA NO. _____________
Place: __________________
Issued on : June18, 1981
Expiring on December 31, 2005
Area: 4.6516 hectares
That our brother/co-heir ______________ died in Iloilo City on January
29, 1998 and __________________ died in unknown place during World War II
and our sister/co-heir _________________ died in Iloilo City on April 14, 1991;
IN WITNESS WHEREOF, we have hereunto set our hands this _______
day of ______________________ 2007 in the City of Iloilo, Philippines.
____________________________
Affiant

__________________________
Affiant

Signed in the Presence of:

________________________ & ______________________
SUBSCRIBED AND SWORN to before me this _______ day of
___________________ in the City of Iloilo, Philippines. Affiant exhibited to me
his
Comm.
Tax
Cert.
No.
__________________
issued
at
_______________________ on ____________________ and Comm. Tax Cert.
No. __________________ issued at _______________________ on
____________________.
Doc. No. _______;
Page No. _______;
Book No. _______;
Series of 2007.