Affidavit of Loss Title

AFFIDAVIT OF LOSS TITLE That I, ANASTACIO CRISOSTOMO, of legal age, Filipino, married to FELIZA TAGARIAN and resident of Barangay San Ignacio, San Mateo, Isabela, after being having been duly sworn on oath in accordance with law hereby voluntarily depose and say: That I am the registered owner of a parcel of land situated in the barrio of Barangay San Ignacio, San Mateo, Isabela. As evidence by TCT . No. T-44570, issued by the Register of Deeds of Isabela, containing an area of (3,766), SQAURE METERS, more or less: That quite of accident, on the ____ th day of _______, _____, more or less, my envelop (folder) fell from my hand while I was on my way to Santiago City. That noted the loss only when upon reaching my destination, I saw that folder was gone, together with my TITLE TCT. No. T-44570 but to no avail; That I am executing this affidavit to attest to all the above facts, and to request the Honorable REGISTER OF DEEDS of Isabela to issue the new owners duplicate of Title No. TCT. No. T-44570; IN TRUTH WHEREOF, I have here unto set my hand this ____________th day of _____________________, _______________ at San Mateo, Isabela.

ANASTACIO CRISOSTOMO (Affiant) __________________________ Issued at __________________ On __________________, 2013 SUBSCRIBED AND SWORN to before me this __________th day of __________________, _____________ Affiant, who exhibited to me his ____________ indicated below the name and signature issued at ____________________.

Doc. No. _______________; Page No. _______________; Book No. ______________; Series of 2013;