REPUBLIC OF THE PHILIPPINES )

PAOAY, ILOCOS NORTE )SS.

AFFIDAVIT OF NON-TENANCY/OWNERSHIP

That I, CAROLYN BUDUAN PACRIS, single, of legal age, and a resident of Brgy.
Masisit, Sanchez Mira, Cagayan, Philippines, through a DEED OF DONATION after having
duly sworn to in accordance with law do hereby depose and states that:

1. I am now the owner of a parcel of land more particularly described as:

“Lot No. 1285-D, CSD-01-007045, AR, VLT, being portion of Lot 1285, CAD
445-D situated at Brgy. #27 Mumulaan, Municipality of Paoay, Province of
Ilocos Norte, Island of Luzon; bounded on the N., points 1-2 by Lot 1285-C, of
the SR Subdivision the Plan; on the E., points 2-3 by Lot 1286, CAD 445-D on
the S., points 3-4 by Lot 1285-E of AR subdivision plan; and on the W., points
4-1 by Lot 1284, CAD 445-D; containing an area of THREE THOUSAND SEVEN
HUNDRED SEVENTY THREE (3,773.00) square meters more or less covered
by OCT No. OC-1079 “
1. I acquired the above-mentioned lot through donation;

2. I have been the owner, possessor and occupant of the said lot since it was
donated to me;

3. This agricultural land was not transferred or sold to anyone nor tenanted
by any person ever since;

4. I am executing this affidavit to attest to the truth hereof and for whatever
legal purposes this may be worth.

AFFIANT FURTHER SAYETH NAUGHT.

IN WITNESS WHEREFORE, we have hereunto affixed our hand this ___________ at

Paoay, Ilocos Norte, Philippines.

CAROLYN BUDUAN PACRIS

Affiant
I.D No. PHILHEALTH: 08-050410475-7

SUBSCRIBED AND SWORN TO before me this ______________ at Paoay, Ilocos

Norte, Philippines by the above-named affiants personally known to me, who are the same
person who personally signed before me the foregoing affidavit and acknowledged that
they executed the same.

Doc. No.________;
Page No.________;
Book No. _______;
Series of ________.