Republic of the Philippines

Department of Environment and Natural Resources

COMMUNITY ENVIRONMENT AND NATURAL RESOURCES OFFICE
CENTRAL PANGASINAN

NOTICE OF APPLICATION FOR RESIDENTIAL FREE PATENT

Notice is hereby given that _______________________________has filed with the office of the

CENR Officer an application under the provisions of Republic Act No. 10023 or “An Act

Authorizing the Issuance of Free Patents to residential Lands” for a Residential Free Patent over

a parcel of land situated in _______________________________________ Particularly describe

as follows: Lot No. ___________________________________________ Containing an area of

_________ SQUARE METERS.

FOR. FRANK VINCENT D. DANGLOSE

OIC, Community Environment and
Natural Resources Officer
 REPUBLIC OF THE PHILIPPINES
PROVINCE OF PANGASINAN
MUNICIPALITY OF ____________
BARANGAY OF _______________

CERTIFICATION

TO WHOM IT MAY CONCERN:

This is to certify that a certain parcel of land identified as Lot No.

_______________________________________, Cad./PLS No. _______________ situated at Barangay
_______________________, Municipality/ City of _____________________, Province of Pangasinan is
owned and possessed by ________________________________.

This is to certify further that the Notice of Application for Residential Free Patent filed by
_______________________ covering the same parcel of land was posted in a conspicuous place of the
land applied for in the bulletin board of Barangay/Municipal hall on the _______ day of
______________ and remained posted until the ______________ day of _________.

That said parcel of land described above has no pending Civil Case or Claim and Conflicts as per
our records as of this date and no boundary encroachment on the adjoining lots. It further certified that
no interested party filed a protest over the Free Patent Application of the subject lot.

Issued for legal and reference purpose this _____ day of ________ 2020 at Barangay
______________________, Municipality of __________________, Province of Pangasinan.

___________________________
Punong Barangay
Republic of the Philippines )
Province of Pangasinan :
Municipality of ___________________ )

JOINT AFFIDAVIT IN SUPPORT OF FREE PATENT

(RESIDENTIAL FREE PATENT APPLICATION)

We, ______________________________, married to ___________________________ and

______________________________, married to ___________________________ both of legal
ages and residents of the Municipality of _________________________ Province of
Pangasinan after having been duly sworn to in accordance with law depose and say:

1. That we personally know __________________________ who has filed application for

residential free patent over a piece of land located at
_____________________________________________________________

2. That we are actual resident of Barangay __________________ City/Municipality of

________________________ and that I know the land applied for very well.

3. That we personally know that the said applicant or his/her predecessor-in-interest.

Has actually resided on and continuously possessed and occupied, under a bona fide
claim of acquisition of ownership, the subject land for at least ten (10) years by
himself or through his predecessor-in-interest.

4. That we are not related to the applicant either by consanguinity or by affinity and not,
in any way, interested in the residential land applied for or in the granting, of a
residential free patent; and

5. That to the best of my knowledge, belief and information, he/she has the
qualifications to apply for a residential free patent under R.A 120023.

IN WITNESS WHEREOF, we have hereunto set our hand this ______ day of ________________, in the
place above first written.

_____________________ _____________________
Affiant Affiant
CTC No. ________________ CTC No. _____________
Issued on _______________ Issued on _____________
Issued at ________________ Issued at _____________

SUBSCRIBE AND SWORN TO before me on the date place state above.

_____________________________
Officer Authorized to Administer Oath
REPUBLIC OF THE PHILIPPINES )
PROVINCE OF PANGASINAN : S.S.
MUNICIPALITY OF ______________ )

AFFIDAVIT
I, ________________________________________ of legal age, Filipino citizen,
and a resident of ______________________________ after having been duly sworn to
in accordance with law, depose and say:

That I am the only holder of Residential Free Patent Application No.

0155________ covering Lot No. __________ situated in the City/Municipality of
_______________ Province of Pangasinan.

That I am the only claimant of the afforested lot during the survey.

That the said lot is no pending hearing in the court under L.R.C/G.L.R.C. Cad
Record No. ____________ none __________ and i recognized the same as public land
in the meantime, i will proceed with my Residential Free Patent Application No. 0155
______________.

That I hold myself solely responsible for any liability, whether civil and/or criminal
that may arise if the land has already been adjudicated as private property and/or
corresponding title and in fact been issued, and for my statement I have made herein
that may found untrue/false; and

That i executed this affidavit freely and voluntarily and fully understand the
content

IN WITNESS WHEREOF, I have hereunto set my hand at the City/Municipalty of

_____________ Province of Pangasinan this ________________ day of
___________________ 2020.

_____________________________
Applicant/Affiant

SUBSCRIBED AND SWORN to before me this ______ day of

_________________ 2020
, at _________________________ Pangasinan affiant exhibiting his/her Community
Tax Certification No. _____________ issued at _____________________ on
_____________________.

______________________________
LMI/DPLI
 Republic of the Philippines
Department of Environment and Natural Resources
Community Environment and Natural Resources Office

APPLICATION FOR RESIDENTIAL FREE PATENT

Application No: ________________ Entry No: _______________

Name of Applicant: _____________________________________________________________

Address: ______________________________________________________________________

Citizenship: ____________________________ Civil Status: _________________________

Age: __________________________________ Place of Birth: _______________________

Date of Birth:___________________________

Location of residential land applied for ______________________________________________

_____________________________________________________________________________

Lot No: _________________________ Pls: ________________________________

Land Area: ______________________ Cad: _______________________________

Applicant’s predecessor-in interest (if any): __________________________________________

Date of entry by applicant or predecessor-in interest upon the residential land applied for: (on or
about) ________________________________________________________________________

I declare, under the penalties of perjury, that my total land holdings are not more than 12
hectares and that this application has been made in good faith and to the best of my knowledge
all information contained herein are and correct.

___________________________
Applicant’s Name and Signature

SUBCRIBED AND SWORN TO before me this ________________ day

of___________________________________.

____________________________
Officer Authorized to
Administer Oath