Republic of the Philippines

Region I
Province of Ilocos Norte
MUNICIPALITY OF _______________
BARANGAY _________________

OFFICE OF THE BARANGAY CHAIRMAN

CERTIFICATION

F.P.A. NO. ____________________

LOT NO. _____________________
CADASTRE OF ________________

APPLICANT ___________________
_____________________________

TO WHOM IT MAY CONCERN:

THIS IS TO CERTIFY that the land applied for Public Land Application
noted above is located at Barangay of _______________, Municipality of
_______________, Province of Ilocos Norte is free from any land dispute,
boundary encroachment of any land conflict or whatsoever as it has been posted
for public knowledge for the purpose.

THIS IS TO CERTIFY FURTHER that such a notice has been posted at

the Barangay Hall for one (1) month and nobody questioned on the said
application for title as per our records.

Given this _____ day of ____________________ 20___.

__________________________
(Signature Over Printed Name)
Barangay Chairman

SRC\macky\form\brgy-cert.doc