REPUBLIC OF THE PHILIPPINES }

PROVINCE OF CAGAYAN }
MUNICIPALITY OF STA. ANA } S.S.

AFFIDAVIT OWNERSHIP

I, ___________________ single, Filipino, of legal age and a resident of

___________________________, do hereby depose and state that:

1) I am the owner and actual occupant/possessor of an

alienable and disposable public agricultural land,
______________ with an area of 902 square meters located at
________________________;

2) My father and now me, have been occupying the

aforesaid property in an open, continuous, exclusive and
notorious possession and in the concept of an owner for more
than 30 years;

3) I hereby execute this affidavit to attest to the

truthfulness and veracity of the foregoing for the issuance of a
Tax Declaration and for any legal purpose/s necessary for my
Free Patent Application.

IN WITNESS WHEREOF, I have hereunto affixed my signature this June

12, 2022, at ___________________, Philippines.

____________________________
Affiant

SUBSCRIBED AND SWORN to before me this 12th day of June 2022 at

_______________________, the Affiant, _______________, personally appeared and
exhibited to me his _______________ issued by the Land Transportation Office.

Doc. No. ____;

Page No. ___;
Book No. IV
Series of 2022.