AFFIDAVIT

I, Maria Teresita Lucas, of legal age, Filipino, and a resident of Brgy. 15,
General Luna St., San Nicolas, Ilocos Norte, after having been duly sworn to in ac-
cordance with the law, hereby voluntarily depose and state that;
That my deceased father MAXIMO TABIOS filed an application for title
for a certain parcel of land described and designated as Lot No. _______ San Nico-
las,Ilocos Norte at Bureau of Land/ DENR Office with FPA No. (1-6) 6644-C.
That recently, I purchased the above-mentioned property by way of Deed of
Adjudication with Sale signed both of my widowed mother and my father’s sib-
lings through separate instruments. The copy of which are hereto attached as An-
nexes “A” and “B”- respectively.
That I hereby attest, verify and confirm that the application for titling of the
aforesaid parcel of land did not materialized nor push through, and I had never
withdrawn norreceived a title of the aforesaid parcel of land from LRA/ Register of
Deeds and the same still remain untitled.
That I am requesting your good office to withdraw/ cancel the application
which my late father previously applied so that the new owner/applicant can now
apply for Free Patent Title of the above subject property.
That I am executing this affidavit to attest to the truth and veracity of the
foregoing facts, to request the Bureau of Lands/ DENR to cancel the application
submitted by my deceased father MAXIMO TABIOS, and for all legal intents and
purposes this may serve.
IN WITNESS WHEREOF, I have hereunto set our hands this ____ day of
________________at Laoag City.

Maria Teresita Lucas

AFFIANT

SUBSCRIBED AND SWORN TO before me this _____ day of

_________________. That I have examined the affiants and they declared to me
that they have read and understood the foregoing, their voluntary act and deed and
that the same are true to the best of their knowledge and based on authentic
records.