REPUBLIC OF THE PHILIPPINES )

DONE IN THE CITY OF BAGUIO ) S. S.

AFFIDAVIT

I, CARLITO P. LAGMAN, of legal age, Filipino, single, with residential address at No. 0311-A
Barangay Cutcut 1, Tarlac after having been duly sworn to in accordance with law, hereby depose
and say that:

1. Sometime in October, 2016, my brother Felixberto P. Lagman handed to me the Original

Owners Duplicate Copy of Transfer Certificate of Title with No. 34264 registered in the
name of our late grandfather Celestino S. Perez located in Barangay Talaga, Capas,
Tarlac, and more particularly described as follows:

TRANSFER CERTIFICATE OF TITLE

NO. 34264

“Lot : 18, Psd-03-015763 (OLT)

Portion : Psu-103476

Location : Talaga, Capas, Tarlac

x x x

Area : Thirty Six Thousand Two Hundred

Ninety Three (36,293) Sq. Meters

x x x.”

2. However, sometime in April, 2019, I discovered the above-mentioned document missing.

Despite earnest efforts to locate the above-mentioned document, it could not be found.

3. I am executing this affidavit for the purpose of reporting the loss of Owners Duplicate
Copy of Transfer Certificate of Title with No. 34264 with the Office of the Register od
Deeds as I intend to petition the appropriate Regional Trial Court to declare the said
document as lost and/or destroyed and to pray for the issuance of a replacement
Owner’s Duplicate.

4. I affirm to the truth of all the foregoing.

IN WITNESS WHEREOF, I have hereunto set my hand this 16 th day of May 2019 in the City of
Baguio, Philippines

CARLITO P. LAGMAN
Affiant

SUBSCRIBED AND SWORN to before me this 16th day of May 2019 in Baguio City, with
affiant showing to me his Senior Citizen’s ID Card with No. __________________ issued on
______________________ at ________________.