Republic of the Philippines}

Province of Bulacan } SS

AFFIDAVIT OF SELF-ADJUDICATION

I, CECILIO MOLINA, of legal age, Filipino, Married and a resident of Bambang

Bulacan Bulacan after having been duly sworn to in accordance with law, depose and
state:

1. That I am the widow of Carmen Molina (Deceased) who died without any last
will and testament on September 7, 2014 in Bulacan, Bulacan as evidenced by her
Death Certificate issued by the Municipality of Bulacan hereto attached as Annex “A”
and made an integral part of this Affidavit;

2. That at the time her death, the Deceased had no debts, liabilities or obligations to
any persons, agency or institution;

3. That the deceased at the time of her death left certain portion of personal
property (“Estate”) particularly described under Tax Declaration Index Number
2018-05003-02662 and 2018-05003-02528 with a total area of about Three
Thousand Six Hundred Sixty Five (3,665) SQM by virtue of her successional rights
with her mother, PURIFICACION MARCELO.

4. That the deceased at the time of her death left certain portion of personal
property (“Estate”) particularly described under Tax Declaration Index Number
2018-05003-05017 with a total area of about SEVEN HUNDRED THIRTY-TWO
(732) SQM by virtue of her successional rights with her father, CONRADO
MARCELO.

5. That pursuant to Rule 74, Sec. 1 of the Rules of Court, I hereby adjudicate unto
myself the above-described Property/ies by means of this Affidavit and hereby files
the same with the Register of Deed of Bulacan with the request that the said
adjudication be made effective without judicial proceeding as prescribed by the
aforementioned provision of the Rules of Court.

IN WITNESS WHEREOF, I have hereunto set my hand this 30th June 2019, at
Bulacan,Philippines

CECILIO MOLINA
Affiant

SUBCRIBED AND SWORN TO before me this 30th June 2019, at Bulacan, Philippines
affiant exhibiting to me his ___________________ issued in ________________ on
____________________.

Doc. No. _____;

Page No. _____;
Book No. _____; ARACELI B. GLORIA
Series of 20___. Commission for Notary Public in
Bulacan
3049 Bambang Bulacan Bulacan
Roll Number 69656
IBP Number 077809 January 7, 2019
PTR 1844512 January 17, 2019
MCLE No. N/A