Republic of the Philippines )

__ ) S.S.

AFFIDAVIT OF NON-TENANCY

I, _____________________________, ____________, of legal age, _________ and a resident of

Barangay _____________________________, represented herein by my Attorney-in fact
_________________________, Filipino of legal age, married and resident of Brgy.
__________________________, by virtue of Special Power of Attorney executed on _________________
at ___________________City before ___________________, a Notary Public for and in the City of
_____________________, registered in his/her Notarial Book as Doc. No. ______, Page No. _______,
Book No. _______, Series of 20__, after having been duly sworn to, in accordance with law,
hereby depose and say;

1. That I am the registered owner of a certain parcel of land located at Brgy.

_______________________, ______________________, consisting of
_____________________________________________________________ SQUARE METERS (_____
sq.m.), covered by Original/Transfer Certificate of Title No. ________.

2. That said land is not tenanted by anybody for the same is under my personal
management and cultivation;

3. That I am executing this affidavit to the truth of the foregoing.

IN WITNESS WHEREOF, I have hereunto set my hand this _______ day of

_________________, 20__________, at _________________________.

______________________
Affiant

Represented by:

Attorney-in-fact

SUBSCRIBED AND SWORN TO BEFORE me, this _____ day of __________________,

20_______ at ________________________, affiant exhibiting to me his/her government issued
identification ___________________________________ issued on ____________________ by
_________________________, bearing his/her photograph and signature.

Doc. No. _______; Notary Public

Page No. _______;
Book No. _______;
Series of 20_____.