REPUBLIC OF THE PHILIPPINES )

SAN NICOLAS, ILOCOS NORTE ) S.S

AFFIDAVIT OF LOSS

I, ALEJANDRO B. MAMUAD SR., of legal age, Filipino citizen, and with registered postal
address at Brgy. 6, San Juan Bautista, San Nicolas, Ilocos Norte, Philippines, after having been
duly sworn to in accordance with law hereby depose and states that:

1. I am the lawful and absolute owner of a parcel of land particularly designated as Lot
No. 6867 located in Brgy. 6, San Juan Bautista, San Nicolas, Ilocos Norte, Philippines
containing a total area of 256 square meters;

2. Vitally, I hereby allocate and partition the said parcel of land as hereunder:

2.1. To ALEJANDRO A. MAMUAD JR. a portion of 52 square meters located in the

western portion of Lot No. 6867, but is now particularly designated as Lot No.
6867-D of the Sketch Plan.

2.2. To DOMINADOR A. MAMUAD a portion of 51 square meters located in the

western portion of Lot No. 6867, but now is now particularly designated as
Lot No. 6867-D of the Sketch Plan.

2.3. To ALEJANDRO B. MAMUAD SR. a portion of 51 square meters located in the

middle portion of Lot No. 6867, but is now particularly designated as Lot No.
6867-C of the Sketch Plan.

2.4. To LILIA A. CAPALUNGAN a portion of 51 square meters located in the eastern

portion of Lot No. 6867, but is now particularly designated as Lot No. 6867-A
of the Sketch Plan.

2.5. To JUANITA M. TUVIDA a portion of 51 square meters located in the eastern

portion of Lot No. 6867, but is now particularly designated as Lot No. 6867-B
of the Sketch Plan.

3. I am executing this affidavit to request the Municipal Assessor of San Nicolas, Ilocos
Norte and the Provincial Assessor of Ilocos Norte to cancel the existing tax
declaration of the said property and issue a new Tax Declaration reflecting the
contents and legal effects of this affidavit; and

4. That I am executing this affidavit to attest to the veracity of my statements and for
whatever intents and purposes it may lawfully serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 18 th day of May 2023 at San
Nicolas, Ilocos Norte, Philippines.

ALEJANDRO B. MAMUAD SR.

Affiant
Id No. ______________

SUBSCRIBED AND SWORN to before me this 18th day of May 2023 at San Nicolas, Ilocos
Norte, Philippines.

Doc. No. 214; Book No. CCXVII;

Page No. 44; Series of 2023.