CONSULATE GENERAL OF THE PHILIPPINES }

CALGARY ALBERT }S.S.

CANADA }

AFFIDAVIT

I, JERRY BALAEG PASIAN, of legal age, married, Filipino citizen and a resident of 650
Chaparral drive Se, Calgary Alberta, Canada, after having been duly sworn to in accordance with law
hereby depose and state that:

1. I am the former common law husband of Mary Lisa Sinaoy also known as Mary Lisa S.
Pasian who is declared owner of that parcel of property land and building covered by ARP
2010-01-004-110208, PIN No. 102-01-004-05-LO77-N002 of the City Assessor’s Office of
Baguio City, Philippines;

2. On September 19, 2017, I executed an Affidavit of Adverse Claim which was duly annotated
in the above-mentioned Tax Declaration;

3. Considering the fact that we have already made some understanding with my former common
law wife, I eventually agreed to have the annotation be cancelled.

4. FINALLY, I am executing this affidavit to attest to the truthfulness and veracity of all the
foregoing allegations and for the purpose of requesting the Office of the Assessor’s Office to
cause the cancellation of the annotation, that is, my affidavit of adverse claim as appearing in
the above-mentioned Tax Declaration and for all legal intents and purposes this may serve.

IN WITNESS WHEREOF, I have hereunto set my hands this ___th day of

________________, 2017 at _____________________, __________________________.

JERRY BALAEG PASIAN

Affiant
Passport No. __________________
Issued on _____________________
Issued at ______________________

SUBSCRIBED AND SWORN TO BEFORE ME, this ____th day of _________________,

2017 at _______________, ___________________, Affiant personally appeared know to me and to me
known to be the same person who executed the foregoing instrument and acknowledged to me that the
same is his free and voluntary act and deed and exhibited to me his valid identification card which is a
sufficient and competent proof of his identity.
 (Ditoy next form-spa...icopy mo name and address ko dta blanks and
ikabil mo dita baba after jay to wit:::
1. To cause the annotation of Affidavit of Adverse Claim/Cancellation of
Adverse Claim over the property Registered in the Tax Declaration of Mary Lisa
S. Pasian in the City Assessor’s Office of Baguio City; and

2. To process and sign documents in my behalf the Sell/Transfer and

accept payment over the Titled Property land of Mary Lisa S. Pasian located at
Municipality of Cordon, province of Isabela covered by TCT No. TSC-15714.)