Republic of the Philippines )
Trece Martires City )Sc.
CANCELLATION AND DISCHARGE OF REAL ESTATE MORTGAGE
I, VIRGILIO B. QUITO, Filipino, of legal age, married and a resident of 428 Brotherhood St.,
Perpetual Village 5, Bacoor, Cavite represented by my Atty-in-fact MARIA BRICELIE QUITO-EGUIA,
Filipino, of legal age, married and a resident of B4 L 11 Banaba St. Alfonso Vill. Alapan IB, Imus, Cavite
after being sworn to in accordance with law hereby depose and state:
1. That I am the registered owner and mortgagor of a parcel of land located in Abagatan,
Gusing Norte, Naguilian, La Union containing an area of SEVEN HUNDRED SIXTY SIX
( 766 ) square meters, with Tax Declaration No. 2009-11-0023-00277 and Lot No. 11147-
B1;
2. That on March 14, 2013, the said parcel of land, being mortgaged for the sum of ONE
HUNDRED THOUSAND PESOS PHILIPPINE CURRENCY (100,000.00php) to IRENE
F. CALICA, Filipino, of legal age, married and a resident of Gusing Norte, Naguilian, La
Union;
3. That upon the corresponding mortgaged agreement, I, Virgilio B. Quito, represented by my
Atty-in-fact Maria Bricelie Quito-Eguia, willing to pay back the ONE HUNDRED THOUSAND
PESOS PHILIPPINE CURRENCY (100,000.00php) to IRENE F. CALICA as full
payment for the release and cancellation of the said mortgaged of the property with Tax
Declaration No. 2009-11-0023-00277 and Lot No. 11147-B1;
4. That I am executing this affidavit in order to attest to the truth of the foregoing declarations
for whatever legal purposes it may serve.
IN WITNESS WHEREOF, I have hereunto affixed my signature this ___ day of ___________
at Trece Martires City, Cavite.
MARIA BRICELIE QUITO-EGUIA
(Attorney-in-fact for VIRGILIO B. QUITO)
Conforme:
IRENE F. CALICA
SUBSCRIBED AND SWORN before me this ____ day of _____________ at Trece Martires City,
Cavite by the affiant who exhibited her TIN ID NO. 171-312-816-000 as proof of identity.
Doc. No. ______;
Page No. ______;
Book No. ______;
Series of 2015.