REEPUBLIC OF THE PHILIPPINES)

PROVINCE OF TARLAC . . . . . . . . .) S.S

CITY OF TARLAC . . . . . . . . . . . . . .)

AFFIDAVIT

I, MERCIDITA M. HARTLEY, of legal age, Filipino citizen, married, and

a resident of Michael St., Kipping Village, Camiling, Tarlac, after having been duly
sworn to in accordance with law, do hereby depose and state:
1. That I am the buyer of a parcel of land, situated at Barangay Cacamilingan,
Norte, Camiling, Tarlac with an area of 278 square meters, more or less and
covered by Transfer Certificate of Title No. 043-2018011177, as evidence by
a duly executed Deed of Absolute Sale dated January 8, 2019, entered in the
notarial Registry of Atty. ENRICO G. BARIN, as Doc. No. 308; Page No. 62;
Book No. CCXIV; Series of 2019 (the “deed”).

2. That in said Deed, my husband’s name does not appear;

3. That I hereby execute this affidavit to attest to the truth that my civil status at
the time that I executed the said Deed and at present, is “ married to Samuel
H. Hartley” ;

4. That this affidavit is being executed to the foregoing facts for the specific
purpose of transferring said property to my name with the Office of the
Registry of Deeds of the Province of Tarlac.

IN WITNESS WHEREOF, I have hereunto set my hand this _________, day

of 2019 at Tarlac City, Philippines.

MERCIDITA M. HARTLEY
Affiant

SUBSCRIBED AND SWORN to before me, a Notary Public for and in the
Province of Tarlac, this ____________ day of _____________, at Tarlac City.
Philippines.

WITNESS MY HAND AND SEAL.

Doc No. ____________ ;

Page No ____________ ;
Book No. ____________;
Series of 2019