AFFIDAVIT OF LOSS
REPUBLIC OF THE PHILIPPINES)
_____________________________ ) S.S.
I, (Name of Affiant)., Filipino, of legal age, residing at (Address of Affiant), after having been sworn in accordance with law hereby depose and state:
That I am the true and lawful owner of a parcel of land which is more particularly described as follows:
TRANSFER CERTIFICATE OF TITLE NO. 65397
A parcel of land with TCT No. 65393 (Lot 3967-G-6, of the subdivision plan, Psd-07-062951, being a portion of lot 3967-F, Psd-07-061347) situated in the Barangay of Maribago, city of Lapu-lapu, island of Mactan. Bounded on the SW., along line 1-2 by Lot 3967-F-4; on the NW., along line 2-3 by lot 3967-F-9 (Road 7.00 m wide), both of the subdivision plan; on the NE, along line 3-4 by Lot 3965 Opon Cadastre; along line 4-5 by Lot 3967-F-8 of the subdivision plan; on the SE., along line 3-6 by 3965 Opon Cadastre; along line 6-7, 7-1 by Lot 3967-F-7; Lot 3967-F-5 both of the subdivision plan. Beginning at the point marked “1” on plan being S. 12 deg. 07’W from BLLM No. 11, Opon Cadastre, thence N. 14 deg. 53’ W., 19.29 m to point 2; thence N. 74 deg. 13’E., 15.90 m to point 5; thence S. 32 deg. 33’W., 0.83 m to point of beginning; containing an area of TWO HUNDRED FIFTY (250) SQUARE METERS more or less, located inside Cebu White Sands Subdivision, city of Lapu-lapu, Cebu.
That sometime in June of this year, I was looking for the original Tax Clearance Certificate but to my surprise, said Tax Clearance Certificate could not be found.
That I took pains to look for said Tax Clearance Certificate, but to no avail;
That I am executing this affidavit to attest to the truth of the foregoing and to request from the City Government to issue a new Tax Clearance Certificate.
IN WITNESS WHEREOF, I have hereunto set my hand this _____ day of _______________. 2012__ at _________________________.
(Name Over Signature of Affiant)
SUBSCRIBED AND SWORN to before me, this ____ day of ______________, 2012 in ___________________ City, with affiant exhibiting his CTC No. _______________ , Issued on ______________________ at _________________________.
NOTARY PUBLIC
Until December 31, 2012
Doc. No. : ________;
Page No. : ________;
Book No. : ________;
Series of 200__.
