Republic of the Philippines]

Province of Cagayan ]S.S

City of Tuguegarao ]

AFFIDAVIT OF CANCELLATION OF ADVERSE CLAIM

I, ________________, of legal age, married, Filipino and a

resident of __________________, after having been duly sworn
to in accordance with law, hereby depose and state, that:

1. I am one of the legal heirs of my deceased mother,

_________________ who is one of the legal heirs of
_____________, the registered owner of Lot No. ______
covered by OCT No________;

2. Without my knowledge and consent, OCT-________

was subsequently cancelled and was subdivided into
four (4) lots under ____________ and one of this is the
___________ registered in the name ________________;

3. In order to protect my rights, I have caused the

annotation of my adverse claim on TCT No.
______________ on 23 August 2016 under Entry No.
______________;

4. After several confrontations with _____________, the

registered owner of TCT No. __________________, have
come into terms and finally settle whatever discord we
had prior to the annotation of the aforementioned
adverse claim;

5. As such, I am executing this Affidavit to request the

Registry of Deeds to cause the cancellation of Entry
No. _______________ in the TCT No. _______________;

IN WITNESS WHEREOF, I have hereunto affixed my

signature this ___________ at Tuguegarao City, Cagayan.

_______________________
Affiant
SUBSCRIBED AND SWORN to before me this
___________ at Tuguegarao City, Cagayan by affiant Pedro P.
Estoista who exhibited to me his _________________ as a
competent proof of their identity.

Doc. No.____;
Page No.____;
Book No.____;
Series of 2024.