REPUBLIC OF THE PHILIPPINES

SECOND JUDICIAL REGION

REGIONAL TRIAL COURT
BRANCH __________
CABARROGUIS, QUIRINO
-oOo-

INRE: PETITION FOR ROCONSTITUTION

OF LOST OWNERS COPY OF
KATIBAYAN NG ORIHINAL NA
TITULO BLG. P-123 LRC/SPL. PROC. NO.
____________

CLARITA BARIS-NAGNAP,
Petitioner
X-----------------------------------------X

PETITION

Comes now the Petitioner through undersigned counsel unto the honorable
court respectfully state:

1. That PETITIONER is of legal age, Filipino citizen, married and residing at

Sto. Domingo, Cabarroguis, Quirino, where summon and other legal
processes will be served upon her;

2. That PETITIONER in her capacity as person interest being the transferee of

certain parcel of land embraced under Original Certificate of Title No. T-
123, consisting of five (5) pages ANNEX “A”, page 2 ANNEX “A-1”, page
3 ANNEX “A-2”, page 4 ANNEX “A-3”, and page 5 ANNEX “A-4” more
particularly described as follows:

“ A PARCEL OF LAND LOT NO.53, GSS-406, SITUATED IN VILLAMOR,

CABARROGUIS, QUIRINO. BOUNDED ON THE E., ALONG LINE 1-2 BY
LOT 52, GSS-406; ON THE S., & W., ALONG LINES 2-3-4 BY ROAD; AND
ON THE N., ALONG LINE 4-1 BY LOT 47, GSS-406, CONTAINING AN
AREA OF TWENTY EIGHT THOUSAND SEVEN HUNDRED SIXTY THREE
(28,763) SQUARE METERS MORE OR LESS.”

3. That PETITIONER acquired the above described property by way of Extra

Judicial Statement w/ Waiver of Rights executed by the heir of the late-
Ambrocio Baris, ANNEX “B” and their Signatures ANNEX “B-1”.
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4. That the owners duplicate copy of OCT No. P-123 was lost from my possession, an
AFFIDAVIT OF LOSS attached ANNEX “C”, and Signature ANNEX “C-1”;

5. That for Taxation purposes, the same was covered under Tax Declaration (TD) No. 067-
02-0001-020-12-0000, annex “D”;

6. CERTIFICATION issued by Municipal Assessor of Cabarroguis, Quirino-Plaridel M.

Uao, ANNEX “E”;

7. That for the forgoing ANNEXES form an integral part of this PETITION ;

8. That the Petitioner is in actual possession and cultivation of the subject land:

9. That exist no Deed of instrument for registration affecting the above described property,
and free from all lien and encumbrances;

WHEREFORE, this Petitioner respectfully prays unto this Hon. Court that after due
publication and hearing to ORDER and DIRECT the Register of Deeds, Province of Quirino to
reconstitute Original Certificate of Title No. P-123 in the registered name of the owner in a manner
exactly in the same terms and conditions on the basis of the copy of said title issued to Petitioner
and copy of the Register of Deeds and further prays other relief which is deem just and equitable.

Diffun for Cabarroguis, Quirino, January 18, 2018.

CLARITA BARIS-NAGNAP
Petitioner

SUBSCRIBED AND SWORN, to before me this January 18, 2018 At Diffun, Quirino.

Atty. MA. KAREN A. BALDONADO-GUILLERMO

Notary Public
Until December 31, 2019
Doc. No . ; PTR No. 3218465/ 01-03-2018
Page No. ; Lifetime IBP No. 17396/05-20-2017
Book No. 01; ROLL No. 67812/05-26-2017
Series of 2018. MCLE Exemption
(MCLE Governing Board Order No. s-2008)
Diffun, Quirino
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VERIFICATION and CERTIFICATION of

NON FORUM SHOPPING

I, CLARITA BARIS-NAGNAP, hereby certify under oath that I have cause the
preparation of the foregoing Petition written in English Language which I can speak and
understand and all allegations supplied by me are verified that all are true and correct of my
own personal knowledge.

That I certified under oath that I have not initiatory commenced any action or filed
any claim involving the same issues in any Court, Tribunal, Quasi-judicial body to the best
of my knowledge that no order ORDER, action claims, pending.

That If should there after learned that the same or similar action or claim has been
filed or pending, I shall report that fact within 5 days to the court wherein such as compliant
or initiatory has been filed.

IN WITNESS WHEREOF, I have hereunto affixed my signature this January 18,

2018 at Diffun, Quirino.

CLARITA BARIS-NAGNAP
Petitioner

Subscribed and sworn, to before me this January 18, 2018, at Diffun,

Quirino.

Atty. MA. KAREN A. BALDONADO-GUILLERMO

Notary Public
Until December 31, 2019
Doc. No . ; PTR No. 3218465/ 01-03-2018
Page No. ; Lifetime IBP No. 17396/05-20-2017
Book No. 01; ROLL No. 67812/05-26-2017
Series of 2018. MCLE Exemption
(MCLE Governing Board Order No. s-2008)
Diffun, Quirino