REPUBLIC OF THE PHILIPPINES)

PROVINCE OF BOHOL )
X-------------------------------------X

AFFIDAVIT OF WITHDRAWAL
OF FREE PATENT APPLICATION

I, ANNABEL PREGUNTA CURIBA, Filipino, of legal age, widow and a resident of Bayongan, San
Miguel, Bohol, Philippines, after having duly sworn to in accordance to law do hereby depose and
state:

1. That, I am one of the legal heirs of Marcelina Pregunta who is also one of the legal heirs of
Anacleto Pregunta who became the owner of a certain parcel of land covered under Tax
Declaration No. 2016-38-0002-00322 with an area of SIXTY-ONE THOUSAND FOUR
HUNDREED SXTY-FOUR (61,464) SQUARE METERS, more or less located at Bayongan, San
Miguel, Bohol, Philippines;

2. That, MARCELINA PREGUNTA, filed an application for free patent of the aforesaid parcel of
land with Lot No.1266, with a total area of SIXTY-ONE THOUSAND FOUR HUNDREED SXTY-
FOUR (61,464) SQUARE METERS, more or less located at Bayongan, san Miguel, Bohol,
Philippines;

3. That, my _________________ applied for Free Patent Application in the office of DENR at
Talibon, Bohol recorded as FPA-071238-707 for which corresponding Patent No.______ dated
April 25, 1996 was issued;

4. That, on ___________________ we among heirs of the applicant executed Deed of Absolute

Sale regarding the aforementioned certain of a parcel of land before Notary Public and duly
acknowledged by Atty._________________under Doc. No._____; Page No.____; Book
No._____; Series of _________as hereto the copy of the same;

5. That, I am requesting the DENR Office Region 7, Talibon, Bohol and other concerned offices
to cancel and revoke any titled issued in the name of Marcelina Pregunta;

6. That, I am executing this affidavit to attest to the truth of the foregoing facts and for
whatever legal purposes this may serve best.

IN WITNESS WHEREOF, I hereby affix my signature this __________________ at Poblacion, San

Miguel, Bohol, Philippines.

____________________________
AFFIANT
ID NO. ____________________

SUBSCRIBED AND SWORN TO before me this _______________ at _____________________,

Philippines by affiants who exhibited to me her respective Valid ID as evidence of identity.

Doc. No._________;
Page No._________;
Book No. _________;
Series of 2021.