Republic of the Philippines

OFFICE OF THE CITY ASSESSOR

Quezon City, Metro Manila

TAX DECLARATION APPLICATION FORM

(SEGREGATION/CONSOLIDATION)

Date filed: ______________________________ __

Control No.: ______________________________

[PLEASE PRINT THIS PORTION LEGIBLY TO AVOID ERROR IN PERSONAL REFERENCE]

RECORD OF OWNERSHIP [TCT/Building plan as reference]

Owners (per TCT):________________________________________________________________________________________________
Spouse name (Sps):__________________________________________ Married to (M/TC):_____________________________________
List of Co-owners: ________________________________________________________________________________________________
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
Owner Address:__________________________________________________________________________________________________
____________________________________________________________TIN_(tax identification no.) _____________________________
Administrator: _______________________________________________ _
Address: _____________________________________________________TIN______________________________________________
MODE OF ACQUISITION:____________________________________Date of Acquisition:______________________________________
Amount of Consideration_____________________________________ _____ Actual Use:_______________________________________
TCT/CCT No._________________________________TCT/CCT Date_____________________Effectivity Year:_____________________
PROPERTY DESCRIPTION:
Street _____________________________________Barangay_____________________________District__________________________
Lot No._____________________________________Blk No_____________________________ _Survey No._______________________
Lot Area________________________Legal Description_____________________________Subdivision____________________________
Kind of Building _______________ Unit No.: ___________________
Building Permit No.____________________________________
Classification/Use_____________ Building No.: __________________ Date Issued:_________________________________________
Type of Building___________Location/Storey:________________
Condominium Name:___________________________________
**For tax declarations involving machinery, details of machinery record should be attached to this form
LAND/BUILDING SKETCH & AREA COMPUTATION: (a separate sheet may be attached)

DOCUMENTARY REQUIREMENTS ATTACHED (Please check appropriate box):

Transfer certificate of Title (Certified copy from RD)

Photocopy of previous title
Deed of Conveyance
(pls check if)
_____ Deed of Sale/Donation

_____
_____
_____
_____

Deed of Exchange
Extrajudicial settlement of estate
Affidavit of Self Adjudication (sole heir)
Deed of conditional sale

PREVIOUS RECORD/REAL PROPERTY TAX PAYMENT

Previous PIN (New PIN)

___________________________________________
Previous Tax Declaration No.
___________________________________________

TCT NO.
FROM

TO

PIN NO.

AMOUNT

OR NO.

DATE

Certified true copy of latest tax declaration

Transfer tax receipt (original & 2 photocopies)
BIR Certificate Authorizing Registration
Tax Clearance from the City Treasurers Office
Affidavit of No Improvement (for vacant lots)
Photocopy of Owners TIN Card or TIN No.
Approved Subdivision Plan (for cons/segr)
Please attach separate sheet, if necessary
Owners authorization/ special power of attorney
______________________________________________________________________________________________________________
Prepared by:

_____________________
Applicant

_____________
Date

_______________________
Receiving Officer

_____________
Date

FORM
102