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AND DECLARE .
1. That the applicant/s is/are the owners of the land (by virtue of inheritance or deed of sale
conveyance and/or possession in accordance with Section 14 of said Decree), together with the buildi
and improvements thereon, with the exception of the following:
________________________________________________________________________________
________________________________________________________________________________
which is/are the property of ___________________________________________________________
residing at _____________________________________. The said land, consisting of ______________
parcel/s is/are situated, bounded and described as shown on the plan and technical description attach
and made a part hereof, with the following exception:
________________________________________________________________________________
________________________________________________________________________________
2. That said land at the last assessment for taxation was assessed at P _________.Philippine c
and the buildings and other improvements at P _________. Philippine currency.
3. That to the best of my/our knowledge and belief, there is no mortgage or encumbrance of
kind whatsoever affecting said land, nor any other person having any interest therein, legal or equitab
possession, other than as follows:
________________________________________________________________________________
________________________________________________________________________________
4. That the applicant/s has/have acquired said land in the following manner: ________________
________________________________________________________________________________
________________________________________________________________________________
(Note: Refer to Sec. 14 of said Decree. State also whether the property is conjugal, paraphernal or exc
property of the applicant/s)
5. That said land is occupied by the following person:
________________________________________________________________________________
6. That the names in full and addresses, as far as known to the undersigned, of the owners o
adjoining properties, of the persons mentioned in paragraphs 3 and 5, and of the persons shown on th
as claimants, are as follows: ____________________________________________________________
________________________________________________________________________________
7. That the applicant/s is/are single or married to _____________________ (Note: if marriage
has been lagally dissolved, state when and how the marriage relation terminated.)
8. That the applicant's/s' full name, age, citizenship, residence, and postal address/es is/are
follows:__________________________________________________________________________
9. That (Note: If the included in the application is bounded by a public or private way or road
should be stated in this paragraph whether or not the applicant claims any and what land within the li
way or road and whether the applicant desires to have the line of the way or road determined.)
________________________________________________________________________________
___________________________________
10. That the following documents are attached hereto and made a part hereof: _____________
________________________________________________________________________________
Signed at ______________________ this ______ day of ____________________________
in the year nineteen hundred and ___________________________.
__________________________
Applicant
__________________________
( Post Office Address)
____________________________________
(Notary Public, or other Officer authorized to
administer oaths)
PTR NO. ____________
_____________
______________
g of ______________
technical description attached hereto
ed at P _________.Philippine currency
ng manner: _________________
______________
appeared before me
____________
and made oath that the statements
cer authorized to