<p>REPUBLIC OF THE PHILIPPINES ) ) S.S.</p><p>AFFIDAVIT</p><p>I, ______, American Citizens, of legal age with residence and postal address at ______, after having been sworn in accordance with law, hereby depose and state that:</p><p>1. I was a natural-born Filipino Citizen, born in ______on ______to Filipino parents, namely: ______and ______who are now residing at ______.</p><p>2. I have lost my Filipino Citizenship through naturalization on ______and since then I have been a citizen of the United States of America.</p><p>3. I am acquiring through purchase a parcel of land located in ______with an area of _____ square meters. I hereby affirm that this purchase combined with all of my other land holdings in the Philippines do not exceed 1,000 square meters aggregate.</p><p>4. I intend to use the aforementioned land for residential purpose upon my permanent return to the Philippines.</p><p>5. I am executing this sworn statement in compliance with Batas Pambansa Bln. 185 and its Implementing Rules and Regulations.</p><p>IN WITNESS WHEREOF, I have hereunto set our hand this ______day of ______at ______.</p><p>______Affiant</p><p>SUBSCRIBED AND SWORN to before me this ______day of ______at ______, affiant exhibiting to me his/her Community Tax Certificate No. ______issued at ______on ______</p><p>NOTARY PUBLIC</p>