Republic of the Philippines

First Judicial Region

Regional Trial Court
Branch _______

The undersigned, _____Henry Smith C. Abalos_____hereby apply to have the land hereinafter described
brought under the operation of the Property Registration Decree, and to have the title thereto registered
and confirmed:

AND DECLARE . . . . .

1. That the applicants/s is/are the owners of the land (by virtue of inheritance in accordance with
Section 14 of said Decree), together with the building and improvements thereon, with the
exception of the
following:__________________________________________________________________ which
is/are the property of _________________________ residing at _________________________
The said land, consisting of ____________________ parcel/s is/are situated, bounded and
described as shown on the plan and technical descriptions attached hereto and made a part
hereof, with the following
exception:___________________________________________________________________

2. That said land at the last assessment for taxation was assessed at P _28,900.00__, Philippine
currency, and the buildings and other improvements at P __16,750.00___, Philippine currency.

3. That to the best of my/our knowledge and belief, there is no mortgage or encumbrance of any
kind whatsoever affecting said land, nor any other person having any interest therein, legal or
equitable.

4. That the applicant/s has/have acquired said land in the following manner: by way of inheritance
from my father, Angel U. Abalos;

(Note: Refer to Sec. 14 of said Decree. State also whether the property is conjugal, paraphernal or
exclusive property of the applicant/s)

5. That said land is occupied by the following person: The undersigned since 1980 and before that
by his predecessor-in-interest since June 12, 1956.

6. That the names in full and addresses, as far as known to the undersigned, of the owners of all
adjoining properties, of the persons mentioned in paragraphs 3 and 5, and of the persons shown
on the plan as claimants, are as follows:
______________________________________________________________________________
__________

7. That the applicant is single (Note: if marriage has been legally dissolved, state when and how
the marriage relation terminated

8. That the applicant's full name, age, citizenship, residence, and postal address are as follows:
Henry Smith C. Abalos, 33 years old, Filipino, #289 Tebeng District, Dagupan City, Panagsinan,
2400, Philippines.

9. That (Note: If the land included in the application is bounded by a public or private way or road,
there should be stated in this paragraph whether or not the applicant claims any and what land
within the limits of the way or road and whether the applicant desires to have the line of the way or
road determined.) ________________________________________
___________________________
10. That the following documents are attached hereto and made a part hereof:
___________________________________ ________________________________

Signed at ___________________ this _____________________ day of ____________________,

in the year nineteen hundred and ______________________.

_________________________
Applicant

_________________________
(Post Office Address)