Republic of the Philippines

Department of Environmental and Natural Resources

Community Environment and Natural Resources Office
Lipa City

REQUEST FOR ISSUANCE OF SCHOOL SITE SPECIAL PATENT

Entry No. _____________
Request No. ___________
Name of School: _____________________________________________________________
Location: ___________________________________________________________________
Division: BATANGAS
Authorized Officer: CARLITO D. ROCAFORT, CESO V
Address: Provincial Sports Complex Compound, Bolbok, Batangas City
Contact No.:

09175190664

Lot No.: ___________________

E-mail: carlito.rocafort@deped.gov.ph
Pls. ___________________________

Cad. ______________________
Area: _____________________

CARLITO D. ROCAFORT, CESO V

Schools Division Superintendent/
Authorized Officer

Attachments:
___ Historical background of possession/occupation
___ Recent photographs with panoramic view and improvements
___ Court certification of no pending land registration case

SUBSCRIBED AND SWORN TO before me this _______ day of _______________________________, 2015

at ________________________________