Republic of the Philippines]

City of Legazpi ] s.s.

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AFFIDAVIT OF ADJUDICATION BY SOLE HEIR
OF ESTATE OF DECEASED PERSON
I, _____________________, of legal age, Filipino citizen, (civil status) and with
address at ________________________ after having been duly sworn to in
accordance with law, do hereby depose and state, that:
1. That I am the only child of (name of father) and his wife/common law wife,
(name of mother) who died at (death place of father) and (death place of
mother) on (death date of father) and (death date of mother), respectively
as evidenced by the Death Certificate issued by (name of office that issued
said Death Certificate and location) hereto attached as Annexes “A” and
“B” and made integral part of this Affidavit.
2. That said deceased left an estate consisting of a parcel of
land/house/house and lot located at _______________, more particularly
described as follows:

“(technical description of the parcel of land)”

3. Said deceased left no debts.
4. That the net value of said estate is Php_________________ and is
therefore subject to estate and inheritance taxes, as evidenced by the
(basis of the estate and inheritance taxes, usually Declaration of Real
Property), hereto attached as Annexes “____”.
5. Pursuant to Rule 74, Sec. 1 of the Rules of Court, I hereby adjudicate unto
myself the above described parcel of land by means of this Affidavit and
hereby files same with the Provincial/City Register of Deeds of
______________ with the request that said adjudication be made effective
without judicial proceedings as prescribed by the aforementioned Rules of
Court.
IN WITNESS WHEREOF, I have hereunto set my hand this
___________________ at ________________, Philippines.

__________________________
Affiant
ID No. ____________________
Issued by _________________
SUBSCRIBED AND SWORN to before me this _________________ at ______________
Philippines, affiant exhibited herself to me his/her Identification Card indicated below his/her
name bearing his/her photograph and genuine signature as competent proof of his/her
identity pursuant to the 2004 Rules on Notarial Practice.
Doc. No._____;
Page No._____;
Book No._____;
Series of ____.