REPUBLIC OF THE PHILIPPINES)

PROVINCE OF LA UNION ) S.S

CITY OF SAN FERNANDO )

AFFIDAVIT ON NON-IMPROVEMENT AND NON TENANCY

I, BELINDA ELEFANTE, of legal age, Filipino Citizen, resident of Brgy. Sagayad,

City of San Fernando, La Union, after having been duly sworn to an oath in accordance with law,
hereby depose and say:

That We are the VENDOR and VEDEE, respectively of a parcel of land located at
Sagayad, City of San Fernando, La Union, containing an area of 1,290 sq. m., more or less,
classified as Url, declared under tax declaration No. 17-049-103268 and designed cad. Lot. No.
18030-B-2-B-2-B;

PORTION SOLD: The Southeast portion containing an area of 100 sq. m. url portion.

That the above described property has no existing improvement as of the present;

That the aggregate are of our land does not exceed five (5) hectares;

IN WITNESS WHEREOF, We have hereunto set our hands, this _____ day of
__________ 2017 at City of San Fernando, La Union.

BELINDA V. ELEFANTE RICHARD G. BALANON

Vendor Vendee
TIN NO. 167-236-741 TIN NO. 935-960-816

SUBSCRIBED AND SWORN TO BEFORE ME, this ____ day of ______ 2017 at
City of San Fernando, La Union.