REPUBLIC OF THE PHILIPPINES )

CITY OF NAGA : S.S

PROVINCE OF CAMARINES SUR )

AFFIDAVIT OF SELF-ADJUDICATION OF THE ESTATE OF THE

DECEASED CARLA DALISAY

I, CARDO M. DALISAY, of legal age, single, Filipino citizen and a resident

of Panganiban, Naga City, Camarines Sur, after having been duly sworn in
accordance with law, depose and say:
1. That I am the only son of CARLA DALISAY, who died without last
will and testament on January 1, 2022 in Naga City Camarines Sur as
evidenced by her death certificate hereto attached as annexed “A”;

2. That at the time his death, my mother had no debts, liabilities or

obligations to any persons, agency or institution;

3. That my mother left a parcel of agricultural land and more particularly

described and bounded as follows:

“A parcel of agricultural land situated at Brgy. Caroyroyan,

Naga City, Camarines Sur containing an area of Thirty
Thousand and Thirty Eight (30,038) Square Meters, more or
less; bounded on the North by Guillermo Austria; on the East by
Barranco; on the South by Barranco; and on the West by
Barranco; covered by Tax Declaration No. 28-0024-00847 of
the Assessor’s Office of Naga City, Camarines Sur with an
assessed value of  P120,500.00”

Motor vehicle specifically describe as follows:

Maker: Toyota Motor no.: 00001

Series: 2020 Chassis No.: 000000
Color: White Plate No.: ABV010
Year model: 2020 File no.: 00000
O.R: 00000 C.R No.: 00000

4. That pursuant to Rule 74, Sec. 1 of the Rules of Court, I hereby

adjudicate unto myself the above-described real estate by means of
this Affidavit and hereby files the same with the Register of Deed of
Camarines Sur with the request that the said adjudication be made
effective without judicial proceeding as prescribed by the
aforementioned provision of the Rules of Court.

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 5. That I subscribed to this affidavit that I am the only surviving legal heir
of my late mother CARLA DALISAY.

IN WITNESS WHEREOF, I have hereunto set my hand this 26th day

of September 2013 in Makati City, Metro Manila, Philippines.   

CARDO M. DALISAY
Affiant

Signed in the presence of:

JUAN DELA CRUZ MARIA LEONORA TERESA

SUBCRIBED AND SWORN TO before me this 3rd day of March

2022 in Naga City, Camarines Sur, Philippines, affiant exhibiting to me her
Philippine Passport No. 123456 issued in Manila on January 12, 2020 and
valid until January 12, 2025.

ATTY. PAHAD D. CADALAY

Notary Public
Commission expires on Dec. 31, 2030
Roll of Attorney Number 55555
IBP No. 55555, January 5, 2020
MCLE Compliance Nos. 511515
paokhancadalay@gmail.com

Doc. No. 1;
Page No. 4;
Book No. 2;
Series of 2022. 

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