CHECKLIST OF REQUIREMENTS FOR FREE PATENT APPLICATION

AGRICULTURAL LAND

Name of Applicant:
Application No.
Lot No. Area: _________ SQ.M.
Location:
Region: 3
Application:
Application Fee:
Documentary stamp( All legal documents)
Affidavit of Landholding
Joint affidavit of two disinterested persons
Notice of applications
Posting
Proof of payment of Taxes
Tax declarations ( indicated classification of land )
Approved Plan or Form V-37
Investigation Report
Certification from LRA/RTC
Certification on the classification of the land
LC No. and date
Transfer of Rights,Deed of Absolute Sale/Deed of Quitclaim/
Deed of Donation or Waiver of Rights
Survey Claimant
TD Verification
ORDER: Approval of Application and issuance of Patent
A title= Acomp.= Acor.=
eL = eD =

Projection
SPA (When applied by Heirs)
__________________________________________________________________
Note: If Classified as A & D ag\fter April 16, 1960, not qualified under RA 6940 Team No.

( ) OK for signature of patent

( ) For compliance of requirement
( ) Return to PENRO/CENRO concerned for certification

COMMENTS/REMARKS:
 REPUBLIC OF THE PHILIPPINES
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
Provincial Environment and Natural Resources Office
San Fernaqndo, Pampanga

APPLICATION FOR FREE PATENT

Local Land Office No.___________

I hereby make application for Free patent to the following described tract of
agriculture public land under the provision of Chapter VII on Commonwealth Act No.
141, as amended to wit: Give as accurate description as possible showing the boundaries
of land having reference to national objects appearing on the ground and permanent
monuments, if any. If the Lot corresponds to a tract, give information on what plans the
lot maybe identified:
______________________

1.A parcel of land (Agricultural) situated in the sitio of __________________

Barangay __________________ Municipality/City of _____________________Province
of Angeles City, Pampanga, Island of Luzon, Philippines, and __ hectares ___ acres
_____ areas.
2. I submit the following statement of facts to show that I am entitled to make this
application.
3. My name is __________________________age______ and my postal address
is ___________________,I am a natural born citizen of the Philippines. My civil status
is (if married state (a) Name (b) place (c) Citizen and residence address of apouse)
__________________________.

And I am not the owner of more than 24 hectares of land.

The following are my near relatives (state their names and relations to the
applicant such as husband or wife, parents, children, brother, etc. If children give their
ages)
________________________________________________________________________
4. The land described and applied for is not claimed or occupied by other person,
but is public land I entered upon and began cultivation of the same as
_______________________ day the day of___________________ and since that date I
have continuously cultivated the land and have made thereon the following improvement
viz:
________________________________________________________________________
etc.(If applicant claims ancestors, paragraph 5,6,7. and 8 must be filed out)
5. That land described and applied for is not claimed or occupied by the other
person but is public land. It was first entered upon cultivated and occupied on or about
the day of______________, at the Municipality of______________ Province of
Pangasinan.

]
 Evidence of ownership is hereto attached and consists of
________________________________________________________________________
____________________________________ etc.
The following are the names and address of the heirs of my ancestors:
NAME POST OFFICE ADDRESS

________________________________________________________________________
________________________________________________________________________

6. I __________________________and the (only heir/ representative of the heirs)

of who is/are ___________ entitled to succeed him according to the laws of the
Philippines.

7. Since the death of my said ancestors, I have cultivated said land, and
improvements now on the land consisting of the following viz:____________________

8. The land has continuously occupied and cultivated by me/us, or said ancestors,
since the date of entry thereon as above–stated, except during the following named,
period when the land was not occupied for the reason stated____________________

9. The land applied for now occupied and cultivated by me/us and to the best of
my knowledge, information and belief. It is otherwise unreserved and non appropriated
and is non-mineral agricultural public land containing no valuable deposits of guano,
coals, or salt and is more valuable agricultural than for forestry or other purposes.

10. That I am not a CARP beneficiary and equally the land applied for is neither
mortgaged to any banking/financial institution nor involved in any civil administrative
cases.

11. The following named witnesses will testify that the allegation on this
application are true:

NAME ADDRESS

With my marital consent:

_____________________ ____________________________
Applicant
AFFIDAVIT

REPUBLIC OF THE PHILIPPINES )

PROVINCE OF PANGASINAN ) :S.S.
CITY/MUNICIPALITY OF ANGELES, PAMPANGA )

12. I ______________________the person making the foregoing application first

been duly sworn upon my oath, depose and say; That I have read or someone reads to me:
and thoroughly understand the forgoing application that I sign the same and this affidavit
in the presence of the Officer who administered the oath that each and every statement in
said application is true.

____________________________
Applicant

13. Before me, at the place aforesaid on this ____ of ______________________,

personally appeared the applicant to me known to be the same whose name appears in the
foregoing application, in my presence signed the said application and subscribed and
sworn to this affidavit.

______________________________
(Officer authorized to administer Oath)
(Land
Investigator/Inspector)
 Republic of the Philippines
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
Provincial Environment and Natural Resources Office
San Fernando, Pampanga

NOTICE OF APPLICATION FOR FREE PATENT

Notice is hereby given that ___________________________________has filed with the CENR
Office an application, under the provisions of Chapter VII of Commonwealth Act No 141, as amended, for
a Free Patent to a tract of land situated in the Barangay of ____________________ Municipality of
_________________________, Province of Pangasinan, Philippines, describe as
follows:_____________________________________________________________________________
____________________________________________________________________________________
Containing an area of______________________________________________
_______hectares, __________________and __________________centares. All adverse claims
to the tract of land above described must be filed in the Office of the DENR-PENRO on
or before the _________day of ___________________, . Any claim not so filed will be forever
banned.

______________________

_____________________________________________________________________________________

REPUBLIC OF THE PHILIPPINES )

PROVINCE OF PANGASINAN )S.S.
CITY/MUNICIPALITY OF _________________)

I, _____________________________________ , married to______________________

Being first duly sworn to depose and say; That he is the same person who made
application for the above described land that a copy of the above notice was posted in a
conspicuous place on the land applied for, on the bulletin board of the barangay the
land is located and the door of the Municipal Building, on the ________day of
_________________, and remained so posted until the_____day of____________________,

___________________________
Applicant

SUBSCRIBED AND SWORN to before me this ______day of __________________,

the affiant exhibited his/her Community Certificate No._____________issued at the
Municipality of _______________________Province of
_________________on____________________,.

_____________________
Land Inspector/DPLI

Paid Filing Fee_________

Under O.R. No._________
Dated________________

Republic of the Philippines

DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES OFFICE
Provincial Environment and Natural Resources Office
San Fernando, Pampanga

Date: _________
The PENR Officer
DENR,PENRO Guagua, Pampanga
Thru: The Land Mgnt. Officer III

Sir:
I have the honor to certify that on ___________________I was on and had examined the land
applied by _________________ ___married to ______________________under Free Patent
Application No. _______ situated in______________, Municipality of ___________,
Province of Pampanga and in conformity with Circular No. 30 reports the following:

1. That the occupation and cultivation of the applicant as far as I have been able to ascertain
dated from __________ and her occupation and cultivation have been continuous, open,
notorious and exclusively;
2. That the said land was first occupied and cultivated by __________________in ______ and
the occupation and cultivation were continued by the applicant who occupied thereto through
_________________________ from his/her_______ who was his/her immediate
predecessor-in-interest.
3. That the applicant is still living/died on _________________and survived by his
_____________who was his/her n/a
4. That the land is being claimed by ______whose post office address is ______________
5. That of the ________ hectares applied for ______ ___________ are under actual
cultivation none hectares are cleared but not cultivated and none hectares are still
untouched.
6. That improvements on the land consist of the following : __________________
7. That the land applied for is entirely inside alienable and disposable agricultural zone under LC
Map No._______ Project No. __________ dated Nov. 21, 1927
8. That the said land has been surveyed and it corresponds as Lot NO. _15214_______ Cad.
_____________, which was ___ ___________by the Regional Trial court of
_______.
9. That the applicant is not the owner of more than 12 hectares;
10. REMARKS: _____________________________________________________________
________________________________________________________________________
11. That I made a thorough ocular inspection of the land applied for, the sketch is reproduced
herein below or attached the dimensions and area thereof and the improvement thereon.
IN VIEW OF THE FOREGOING, it is respectfully recommended that the patent be now granted to
the applicant.

RECOMMENDING APPROVAL Very truly yours,

____________________ ________________
LMO III SLI/LMI/DPLI

SUBSCRIBED AND SWORN TO BEFORE this __day of __ ____2012 at DENR, PENRO

Pangasinan the SLI/LMI/DPLI with Community Tax Certificate No. _-_________issued on
_________________ at ______________.

______________
 PENR Officer

REPUBLIC OF THE PHILIPPINES

DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
Provincial Environment and Natural Resources Office
San Fernando, Pampanga

F P A No. ___________ Lot No. __________

Barangay:_____________
Municipality:____________
Province:______________
Applicant: : ______________________ Area: ________ sq.m.

ORDER OF APPROVAL OF APPLICATION AND ISSUANCE OF PATENT

From the record of this case, it appears:

1. That the applicant is a natural-born citizen of the Philippines and otherwise qualified to
acquire public land through free patent;
2. That the land applied for has been classified as alienable and disposable and is subject
to disposition under the public law;
3. That upon investigation conducted by __DPLI _____ whose report was duly examined
and reviewed by _____________ it was found out that the land applied for has been
occupied and cultivated by the applicant himself and/or through his predecessors in
interest since ______________ or prior thereto;
4. That the notice for the acquisition of the land by the applicant under this application has
been published in accordance with law, and that no other person has prove a better right
to the applied for;
5. That there is no adverse claim involving the land still pending determination in the Office;
and
6. That the claim of the applicants is in all other respects, complete and there is no record in
this Office for any obstacle to the issuance of the patent.

WHEREFORE, the occupation and cultivation of the Land applied for as described in the

caption hereof is hereby confirmed and this application is hereby in the records of this Office

as Free Patent Entry No. _______.

As the applicant has already complied with all the requirements of the law for the issuance of the
corresponding patent to the land, it also hereby ordered that the necessary patent be prepared for the
issuance in favor of the applicant.

Recommending Approval: For and by Authority of the Secretary

Department of Environment and Natural
Resources Office
________________ ________________________
LMO III PENR Officer

Copy furnished:
No pending claims/conflicts as per
Records to date.____________

Republic of the Philippines

Department of Environment and Natural Resources
Provincial Environment and Natural Resources Office
San Fernando Pampanga

APPLICATION FOR RESIDENTIAL FREE PATENT

Application No._____________________________ Entry No. _________________

Name of Applicant: _______________________________________________________

Address: ________________________________________________________________

Citizenship: __________________________ Civil Status _____________________

Age: ______________ If minor, name of legal guardian __________________________

Date of Birth: __________________________ Place 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 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 true and correct.

___________________________________
Applicant’s Name and Signature
SUBSCRIBED AND SWORN to before me this _____________________ day of
___________________________________.

________________________________
Officer Authorized to Administer
Oath

Republic of the Philippines

Department of Environment and Natural Resources
PROVINCIAL ENVIRONMENT AND NATURAL RESOURCES OFFICE
San Fernando, Pampanga

NOTICE OF APPLICATION FOR

AGRICULTURAL FREE PATENT

Notice is hereby given that Ms./Mrs./Mr,_______________ has filed with the

Office of the PENR Officer an application under the provision 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 __Brgy.______________,
Pampanga particularly described as follows:

Lot __________________

Containing an area of:_ ________________________________(______) SQ. M.

________LEDUINA S. CO ____
Provincial Environment and Natural
Resources Officer
 Republic of the Philippines
Department of Environment and Natural Resources
PROVINCIAL ENVIRONMENT AND NATURAL RESOURCES OFFICE
San Fernando, Pampanga

CERTIFICATE OF POSTING OF NOTICE OF

APPLICATION FOR RESIDENTIAL FREE PATENT

This is to certify that the 15th day posting requirement

for the application of _______________ for residential free patent
under R.A. 10023 of covering a parcel of land identified as
Lot__________________ located in __Brgy. ,Pampanga, has
been completed on ______________. Posting date:______________
to __________________ Posted at Barangay Hall, __Brgy. _________
Pampanga and DENR-PENRO, Guagu, Pampanga.

_________ _______________________
Provincial Environment and Natural
Resources Officer