(DATE)

The Register of Deeds

Angeles City

Sir:

Pursuant to the provision of Section 86 of Presidential Decree No. 1529, I

respectfully request for the cancellation of the annotation of the legal encumbrance
appearing on the accompanying Transfer Certificate of Title Nos.
____________________, __________________ and ______________________ of the
Register of Deeds of Angeles City, relative to the liabilities or contingent claims of
any heirs, creditors or other persons who might be deprived of lawful
participation as imposed by Rule 74, Section 4, of the Rules of Court, in as much
as the two (2) year period has already expired without anybody having presented
any claim whatsoever in relation thereto. The undersigned is the registered owner
of the lots covered by the subject titles and it is submitted that said annotation may
now be cancelled so as to free or release said title of the subject lien or
encumbrance.

Hence, it is requested that this petition be favorably acted upon by your

good office.

Very truly yours,

_____________________
Registered Owner

SUBSCRIBED and SWORN before me this ______________________ at

____________________, by affiant who exhibited to me her (Government Issued ID),
issued in ______________________________ and valid until
________________________.

WITNESS MY HAND AND SEAL, on the date and place first above
written.

Notary Public