Republic.of the Philippines Department of Environment and Natural Resources a- Visayas Avenue, Dilirnan, Quezon City

s Tel Nos. 9294626 to 29; 9294633 to 35 926-7041 to 43: 929-6252: 929-1 669

Website: http;lEwww.denr.gov.ph IE-mail: web@denrgov.ph

MAY 3 1 2090

DENR Memorandum Circular No. 2010- 11

SUBJECT : PRESCRIBING THE FORMS FOR THE PROCESSING OF RESIDENTIAL FREE PATENT APPLICATION8 UNDER R.A. 10023 AS IMPLEMENTED BY DENR ADMINISTRATIVE ORDER NO. 2010-12 DATED 5 MAY 2010

In the interest of the service and pursuant to the provisions of Republic Act No. 10023, otherwise known as "An Act Authorizing the Issuance of Free Patents to Residential Lands," as implemented by DENR Administrative Order No. 2010-12 dated 05 May 2010, the following forms are hereby adopted and shall be used in the processing of residential free patent applications.

A. For Residential Free Patent Applicants:

1. Application Form 2. Checklist of Requirements for Applicants 3. Affidavit of Disinterested Person

B. For DENR-CENRO

1. Checklist of Documents 2. Notice of Application 3. Certificate of Posting of Notice of Application 4. Investigation and Ocular Inspection Report Form 5. Order of Issuance of Free Patent

These forms are strictly not for sale and may be photocopied or reproduced.

This Circular takes effect immediately.

3.-RACIo c.E g o r D E ~ Z ~ ~ ~ ~ ~ Z X Y E N ~

AND NATURAL RESOURCES

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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 : 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 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 infomation contained herein are true and correct.

Applicant's Name and Signature

SUBSCRIBED AND SWORN TO before me this day of

at

Officer ~uthorized to Administer Oath

This form is not for sale This form must be accomplished in five (5) copies.

Republic of the Philippines Department of Environment and Natural Resources

Provincial Environment and Natural Resources Office

ORDER. ISSUANCE OF RESIDENTIAL FREE PATENT

It appearing that in an investigation conducted by the Land

Investigator/Inspector whose report was duly submitted, and the

records of the application duly endorsed by the CENRO, it has

been ascertained that the applicant, Mr/ M s

over a parcel of

residential land situated at

under Residential Free

Patent Application No. has all the necessary

qualifications as required by R.A. 10023 for a grant of a

residential free patent and that the necessary notices has been

posted, and that no other person has proved a better right to the

land subject of the application. It is HEREBY ORDERED that the

patent be prepared and issued to the applicant.

Provincial Environment and Natural Resources Officer