LTC Form No.

Republic of the Philippines ) LTC Application No._______

City of Naga ) S.S

APPLICATION FOR ISSUANCE OF LAND TRANSFER CLEARANCE

That I , ANNA LIZA O. EVANGELISTA of legal age, Filipino, married with residential address at
Santa Rosa Del Sur Pasacao , Camarines Sur, Philippines, , after being sworn in accordance with
law, hereby depose and state;

1. That I as an attorney in fact of ROMEO De OCO in a Deed of Absolute Sale involving a parcel of
land covered by Transfer Certificate of Title No. RT-799(19951) with an area of 196,825
square meters under Tax Declaration No. 97-002 located at Bagolatao Minalabac,
Camarines Sur.

2. That this application for the issuance of Land Transfer Clearance (LTC) is not contrary to law
because both of us are qualified to dispose and acquire the land described above. In addition,
the said land is neither covered under the agrarian reform program nor within the CARPER
LAD balance, and that the deed/contract will not violate the retention limit provided under the
law;

3. In support thereto and in compliance with DAR A.O. No. _______, Series of 2020, the mandatory'
documents are hereto attached and made integral parts hereof as (please check appropriate
box):

3.1 FOR THE TRANSFEROR:

Official Receipt and Electronic Copy of the Title :Annex ________

Deed or document to be registered :Annex ________
Affidavit of Aggregate Landholding :Annex ________
Affidavit of Retention, Non-Tenancy/tenancy with Redemption and :Annex ________
no pending case before regular courts or any other tribunal involving
the lands subject of the transaction, if there is a case before the regular
courts or any other tribunal the same had been decided with finality
Municipal Assessor’s Certificate of Aggregate Landholdings
City Assessor’s Certificate of Aggregate Landholdings :Annex ________
Provincial Assessor’s Certificate of Aggregate Landholdings :Annex ________
:Annex ________
3.2 FOR THE TRANSFEREE:

Affidavit of Aggregate Landholding :Annex ________

Municipal Assessor’s Certificate of Aggregate Landholdings :Annex ________
City Assessor’s Certificate of Aggregate Landholdings :Annex ________
Provincial Assessor’s Certificate of Aggregate Landholding :Annex ________
Municipal Agrarian Reform Program Officer Certification :Annex ________
(LTC From No. 2)

4. Having submitted/attached hereof the mandatory documents as required under DAR A.O. No.
04 Series of 2021, we hereby file this instant application/ request to facilitate the issuance of
the corresponding Certificate of LTC.

IN WITNESS WHEREOF, we hereby sign this joint affidavit this _____day of _______2022 at
Naga City, Camarines Sur, Philippines.
 LTC Form No.1

ANNA LIZA O. EVANNGELISTA

Vendor/Applicant Vendor/Applicant
VID 1727-0021A-D1769Aoe20001-6

Vendee/ Applicant

SUBSCRIBED AND SWORN to before me this _________day of 20_________at Naga City affiants
upon exhibiting to me their duly issued government IDs with details stated above.

Doc No. _________;

Book No. __________;
Page No. __________;
Series of 20________

Copy Distribution:
Original - DARPO/LTC Folder
Duplicate- Applicant