Republic of the Philippines

Department of Environment and Natural Resources

COMMUNITY ENVIRONMENT AND NATURAL RESOURCES OFFICE
Catagbacan, Goa, Camarines Sur

APPLICATION FOR RESIDENTIAL FREE PATENT

Application No._____________________ Entry No. _____________________

Name of Applicant: RAUL ARCILLA DY-COK

Address: 209 VILLA GRANDE HOMES, CONCEPCION GRANDE, NAGA

CITY

Citizenship: FILIPINO Civil Status: MARRIED

Age: 62

Date of Birth: JUNE 7, 1954 Place of Birth: CARAMOAN,

CAMARINES SUR

Location of residential land applied for: BRGY. TAWOG, CARAMOAN,

CAMARINES SUR

Lot No. 639 C Pls:

Land Area: 200 sq. m. Cad: Csd-05-020414-D

Applicant’s predecessor-in-interest (if any): SALOME A. DY-COK

Date of entry by applicant or predecessor-in-interest upon the residential applied

for: APRIL 22, 1956

I declare under the penalties of perjury that my total landholdings are not
more than twelve (12) hectares and that this application has been made in good
faith and to the best of my knowledge all information contained herein are true and
correct.

RAUL A. DY-COK
Applicant

SUBSCRIBED AND SWORN to before me this ___ day of _____________

2016 at________________________________.

AMELIA B. ARIMADO
Officer Authorized to
Administer Oath