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EXTRAJUDICIAL SETTLEMENT OF ESTATE

WITH WAIVER OF SHARE

KNOW ALL MEN BY THESE PRESENTS:

WE, xxx of legal age, widow Filipino citizen, and a resident of Lucena City, xxx,
of legal age, married, Filipino citizen and a resident of Lopez, Quezon, and xxx, of legal
age, widow, Filipino citizen, and a resident of Lucban, Quezon.

WITNESSETH:

1. That the above named parties are the brother and sisters and the sole heirs of
the deceased xxx who died on February 4, 1969 at Lopez, Quezon;

2. That said deceased who died as single, without any children by reason of
marriage or otherwise, died intestate without Will or Testament, and without any
outstanding debts in favor of any person or entity;

2. That said deceased left a certain real property, including all the
improvements existing thereon, exclusively owned by him, and more particularly
described as follows:

OCT NO.
Office of the Register of Deeds for the Province of Quezon

“A parcel of land …..”

That pursuant to Sec. 1, Rule 74 of the Revised Rules of Court of the Philippines,
and the parties herein being all of legal age they have agreed to divide as they do hereby
divide and adjudicate the real properties above described, in equal shares.;

That they hereby affirm that they have executed the foregoing instrument out of
their own voluntary free will without force, intimidation or violence upon their person,
that they have hereby received their just and proper share and have no claim or demand
against each other.

That we, xxx and yyy for our part, do hereby WAIVE all our rights, interest, and
participation in the above-described real property in favor of zzz in like shares.

That no personal properties are involved in this extra judicial settlement;

IN WITNESS WHEREOF, we have hereunto set our hands, this____ day of

_____at Lucena City, Philippines.

WITNESSES:

_______________________________

_______________________________
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REPUBLIC OF THE PHIL.)

CITY OF ________

BEFORE ME on the date and at the place above written personally appeared the
above named persons, all known to me and to me known to be the same persons who
executed the foregoing instrument and acknowledged to me that the same is their free and
voluntary act and deed.

The foregoing instrument relates to Extrajudicial Settlement of Estate With

Waiver of Share of one (1) parcel of land consisting of two (2) pages including the page
on which this acknowledgment is written, and have been signed at the bottom and on the
left hand margin of all the pages thereof, by the parties and witnesses, and sealed with my
notarial seal.