Republic of the Philippines )

Province of Tarlac
)
Municipality of Camiling
) s.s.

AFFIDAVIT OF LOSS
I, NENITA GORMAN y SOBRESIDA, 69 years old, widow, Filipino
citizen and a resident of Arellano St., Poblacion B, Camiling, Tarlac,
Philippines, after having been duly sworn to in accordance with law, do
hereby depose and state that:
1. Sometime in 1971, I purchased a cemetery lot (Lot ABCD,
Block 91, Sec. Memory Garden IV)at the Manila Memorial
Park, Sucat, Paranaque City and I was issued a contract with
number 14488 which I kept, together with my other personal
documents, placed inside a drawer in my room;
2. Lately, when I was organizing my personal effects, I discovered
that the said contract was missing. Thus, I tried to locate the
same from the other drawers and cabinets inside our house but I
found nothing. I also asked the members of my household if they
have seen it but all answered in the negative;
3. All my diligent efforts exerted to locate the said Manila Memorial
Park Contract proved futile; hence, I now consider the same as
lost and beyond recovery;
4. I am executing this affidavit to attest to the truth of the
foregoing statements and for all legal intents and purposes this
may serve.
IN WITNESS WHEREOF, I have hereunto affixed my signature
this 7 day of December 2016 at Camiling, Tarlac, Philippines.
th

NENITA S. GORMAN
Affiant
SUBSCRIBED AND SWORN to before me on the date and place as
above-stated. Affiant exhibited before me her Voter Certification with VIN:
6903-0120A-B1547NSG20000-8 issued by the COMELEC, Camiling,
Tarlac.

Doc. No.________;
Page No.________;

Book No.________;
Series of 2016.