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LORENZO
REPUBLIC OF THE PHILIPPINES)
CITY OF PASIG ) S.S.
I, ROGELIO LIM LORENZO, of legal age, Filipino citizen, married and with residence at
No. 43 Catalina Subdivision, Barangay Rosario, Pasig City, after having been sworn in
accordance with law, hereby depose and say:
That I am the surviving spouse of the deceased IRENE CAINA LORENZO as evidenced by
Marriage Contract No. 1776 (f-83) issued by the Civil City Registry of City of Manila , copy of
which is hereto attached and marked as ANNEX “A”.
That I am the sole and only surviving legal heir of the late IRENE CAINA LORENZO, since
she did not bear any child during our cohabitation, who died on February 4, 2005 at the Rizal
Medical Center of breast cancer, leaving without any will or debt that has not been settled up
to the present. Copy of Certificate of Death No. 2005-500 issued City Civil Registry of Pasig City
is hereto attached and marked as ANNEX “B”.
That the said deceased at the time of her death left a conjugal parcel of residential land
situated at Barangay Rosario, Pasig City which is more particularly described to wit;
That pursuant to Sec. 1 Rule 74 of the Revised Rules of Court of the Philippines, I hereby
Adjudicate unto myself the above described parcel of land without judicial proceedings as
prescribed by the aforementioned Rules of Court.
IN WITNESS WHEREOF, I have here unto set my hand this _____day of August 2018 at
Pasig City.
ROGELIO L. LORENZO
Affiant
SIGNED IN THE PRESENCE OF:
1.____________________________ 2.______________________________
Witness Witness
SUBSCRIBED and SWORN to before me, this _______day of August 2018 at Pasig City by
Rogelio L. Lorenzo with his valid Senior Citizen Identification No.______________ issued on
___________________ , at Pasig City as proof of his identification.