FORM NO.21.

AFFIDAVIT OF SELF- ADJUDICATION

Affidavit of Self- Adjudication

REPUBLIC OF THE PHILIPPINES)

CITY OF BAGUIO ) S.S.

I, MENTAL E. GREY, of legal age, Filipino citizen,

presently residing at #23 Green valley, Baguio City,
Philippines, under oath, state:

1. That I am the sole heir of the late Fernando D. Grey,

being his only biological son;

2. That the late Fernando D. Grey passed away on

January 2, 2017, and died without any last will and
testament;

3. That at the time of death of my father, he had no

debts, liabilities or obligations to any persons,
agency or institution;

4. That the only property left by my late father is a

house and lot,
more particularly described as follow:

OCT No. T-6342 A PARCEL OF LAND (Lot 78 of the

consolidation subdivision plan (LRC) Pcs-4541,
being a portion of the consolidation of Lots 2
and42, Psu-1466287 Amd., LRC (GLRO) Rec. No.
N-17511), situated in the Pines wood ville
subdivision, Green valley, Baguio City. Bounded on
the NE., points 7 to 4, by Lot 12; on the S., and
points 7 to51 by Lot 56; on the SW., points 4 to 2,
by Lot 31; and on the N., points 2 to 3 by Lot 35,
all of the consolidation-subdivision plan. Beginning
at a point marked "1" on plan, being N. 51 deg.
36' E., 1321.76 m. from B.L.L.M. No.1, Sta. Rosa,
Laguna

5. As sole heir of the herein decedent, I hereby

adjudicate the abovementioned property solely for
and in my name as well as any and all liabilities
arising from the said property; and

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 6. I hereby execute this affidavit for the purpose of
processing the transfer of the said property in my
name, the settlement of the estate of the late
Fernando D. Grey, as well as for the release of any
BAGUIO CITY,
other claim or benefit in relation to his death before
PHILIPPINES
any government/private office and banking
institution and for any other legal purpose this may
best serve.

Affiant further says none.

IN TRUTH WHEREOF, I have hereunto signed my name

below, this day of 26 January, 2017 in the City of Baguio,
Philippines.

Mental E. Grey
Affiant

SUBCRIBED and sworn to before me, this day of 26

January 2017, in the City of Baguio, Philippines, by Mental E.
Grey exhibiting to me her Social Security Card with no.
873635 issued on August 13, 2016 at Baguio City,
Philippines.

ATTY. DENVER A.
GAMLOSEN
NOTARY PUBLIC
#1 Feliz Loy Building, Shuntug
Street, Bokawkan road, Baguio
City Commission Serial No.
105
BAGUIO CITY, Until December 31, 2017
PHILIPPINES Roll No. 10987
P.T.R. No. 0007, 1/4/2017,
Doc. No. _21___;
Baguio.
Page No. _21__;
IBP No. 0003, 1/9/2017,
Book No. __4__;
Series of 2017. Baguio.
MCLE Compliance No. 1234

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