Republic of the Philippines )

____________ ) S.S.

SWORN DECLARATION OF IMPROVEMENT

I, xxxxxxx, of legal age, Filipino, married to xxxxxxx and a resident of xxxxx,

Philippines, under oath depose and state that:

1. I am the Attorney-in-Fact of the HEIRS xxxxx who died without will/intestate on

xxxxx in the XXXXXX, Philippines.

2. For and in behalf of the HEIRS OF xxxxx, I am executing this SWORN

DECLARATION OF IMPROVEMENT to attest that the residential parcel of land under
TRANSFER CERTIFICATE OF TITLE No. xxxxx registered in the name of the deceased xxxxx
has improvements standing thereon in the form of her family home as well as plants and
fruit trees that the deceased xxxxxx planted during her lifetime.

3. The family home of the deceased xxxxxx is properly declared for taxation
purposes under Tax Declaration No. xxxxxx with the City Assessor, xxxxxx.

4. I am executing this declaration in compliance with the requirements of the

Bureau of Internal Revenue (BIR) for the purpose of facilitating filing and paying the Estate
Tax and reuesting for the immediate issuance of the Estate Tax Clearance of the Estate of
xxxxxx. AFFIANT FURTHER SAYETH NAUGHT.

IN WITNESS WHEREOF, I have hereunto affixed my signature this ______, in _______,

Davao del Sur, Philippines.

xxxxxx
Attorney-in-Fact of the Heirs of xxxxxx

SUBSCRIBED AND SWORN to personally before me this _______________, in xxxxxx,

Philippines, by the affiant who has satisfactorily proven her identity to me by exhibiting her
above-indicated competent evidence of identity.