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Republic of the Philippines)
Done in the City of Baguio) s.s.
AFFIDAVIT OF SELF-ADJUDICATION
I, ELVIE COLAS KILEY, of legal age, widow, Filipino citizen, with
residence and postal address at No. 30 Tacay Rd., Guisad, Baguio City,
Philippines after having been duly sworn to in accordance with law hereby
depose and states:
1.That I am the only surviving spouse of the late FRANKLIN STEVE Y.KILEY who died intestate on December 20, 2009 at Pines Hospital,
Baguio City (copy of his death certificate is hereto attached as Annex
A and made an integral part hereof), leaving a two (2) unit taxi,
however, only one (1) unit is registered in his name and the other one
(1) is not yet transferred to him and more particularly described as
follows:
UTILITY VEHICLE REGISTERED IN THE NAME OF MY LATE HUSBAND
MAKE: TOYOTA
SERIAL/CHASSIS NO: LF82-6005584
MOTOR NO: 2L-5437580
PLATE NO: AYR 523
MV FILE NO: 1308-00000277634SERIES: REVO
MODEL: 2004
COLOR: WHITE
CR NO: 5612136-5
UTILITY VEHICLE REGISTERED IN THE NAME OF FLORENCE L. KILEY
MAKE: TOYOTA
SERIAL/CHASSIS NO: LF82 6000845MOTOR NO: 2L 9782155
PLATE NO: AYP 498
MV FILE NO: 1380 00000261270
SERIES: REVO
MODEL: 2003
COLOR: WHITE
CR NO: 9219952-0
(For complete technical descriptions please see attached photocopy of
CR No. 5612136-5 and 9219952-0 and marked as Annex B and
C, respectively and made an integral part hereof.)
2.That at the time of his death, said decedent left no will and obligation;
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3.That it is to the best of my interest I hereto adjudicate unto myself thesaid two (2) unit taxi and subsequently will be transferred in my
name;
4.That this instrument is published in a local newspaper of generalcirculation for three (3) consecutive weeks in compliance with its
proper and due registration;
5. I am executing this affidavit to attest to the veracity and truthfulnessof the foregoing statements and for all legal intents and purposes it
may serve.
IN WITNESS WHEREOF, I have hereunto affixed my signature this
_______ day of __________________, 2012 at Baguio City, Philippines.
ELVIE COLAS KILEY
Affiant
WITNESSES: __________________ __________________
Republic of the Philippines)
Done: City of Baguio ) S.S.
ACKNOWLEDGEMENT
Before me a notary public for and in the City of Baguio, this ______day of
______________, 2012, personally came and appeared ELVIE COLAS KILEY
personally known to me and presented to me her __________________________
an integrally complete instrument for identification and she acknowledged to me that
the same is her own free act and deed.
I further certify that the foregoing instrument, consisting of Two (2) pages,
including the acknowledgment, relate to AFFIDAVIT OF SELF-ADJUDICATION
pertaining to two (2) unit of taxi, signed by the affiant thereto and her witnesses.
WITNESS MY HAND AND NOTARIAL SEAL.
Doc. No. _________;
Page No. ________;
Book No. ________;
Series of 2012.
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