Republic of the Philippines

Department of Environment and Natural Resources

Community Environment and Natural Resources Office
Bantay, Ilocos Sur

APPLICATION FOR FREE PATENT

Application No. ____________________ Entry No. _______________

1. I HEREBY make application for free patent the following described tract or agricultural public land
under the provision of Chapter VII of Commonwealth Act No. 141, as amended of Republic Act
No. 9176 (if the land subdivision of cadastral lot, mention the lot survey:
_______________________________________________________________, situated in the
Sitio of ____________ Barrio of _________________ Municipality of Sta. Mari, Ilocos Sur, island
of Luzon, Philippines, and containing an area of __________, hectares ___________, areas
__________ contras a sketch of which is attached.

2. My name is ___________________________________, my post office addressed is

____________________________________, my age is ________ years: my birthplace is Sta.
Maria, Ilocos Sur, I am a natural born citizen of the Philippines; my civil status if (if married, state
name, birthplace, citizenship and residence address of spouse).
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
The name of my father is ______________________ a citizen of the Philippines. The following
are my near relative (state their names and relations to the applicant such as parents, children,
brother, etc. if children give their ages)
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________

3. I am not the owner of more than 3 hectares of land.

4. I am not a CARP beneficiary.

5. The land described and applied for is not claimed or occupied by any other person but it is a
public land, which was first occupied and cultivated by ___________________________ on
_____________________, and since the date I have continuously cultivated the land; and have
made thereon the following improvements ____________________________.

6. The land applied for was entered upon, cultivation and occupied on or about the _______ day of
___________, 20___ by _________________ who was my __________________. My said
ancestor died on the _____ day of ______________, 20___ at ___________________ province
of ___________________. Evidence of ________________ relationship, death, burial and
heirship is hereto attached and consist ______________________. The following are the names
and address of the heirs of my ancestors.

NAME POSTAL OFFICE ADDRESS

_____________________________________________________________________________
_____________________________________________________________________________

7. I am the _________________________________ only heir representive of the heir of

_________________________________entitled to succeed him according to the law of the
Philippines.

8. Since the death of my ancestor, I have cultivated the said land and existing improvements
thereon consist of the following:

_____________________________________________________________________________

9. The land has continuously occupied and cultivated by me or any said ancestor since the date of
my entry thereon at the above stated except during the following period, when the land was not
occupied or the reason stated ____________________________________.