City Assessor

Cagayan de Oro City

Sir/Madam:

To enable us to comply the provision of Republic Act 7160 Sec. 202*, may we request your assistance
in the preparation of Tax Declaration covering the building and/or improvement described hereunder, to wit:

1. Name of Declared Owner :___________________________________________________________

2. Name of Spouse :___________________________________________________________
3. Exact Address :___________________________________________________________
(No.) (Street) (City/Municipality)
4. Description of Building
(a) Type of Building :___________________________________________________________
Total Floor Area (sq.m) :_____________________ Total Area Pavement: ____________________
Total Area Mezzanine :_____________________Total Area Fence: ________________________
(b) No. of Storey/Floor :____________________________________________________________
5. Exact Location of Construction :____________________________________________________________
6. Building Permit No. & Date Acquired: _______________________________________________________
7. Date of Construction Started :____________________________________________________________
8. Date of Construction Completed : __________________________________________________________
9. Date Building Occupied :____________________________________________________________
10. Total Cost of Materials :____________________________________________________________
11. Total Labor Cost :____________________________________________________________
12. Over-all Cost of Building to be declared: _____________________________________________________
13. Name of Lot Owner :_________________ Lot No. __________________ Tax Dec. No. _______________

This is to certify that the above-mentioned information is true to my knowledge and belief.

___________________________ ___________________________________
Signature of Lot Owner Signature of Owner over printed name/
Authorized Representative

I further certify that the cost and the construction of the building covered by the Building Permit No.
_________________ issued on _______________ has been completed in accordance with the approved plans
on file with the Office of the Building Official (P.D. 1096).

_______________________________________
Signature of Architect/Civil Engineer
(In-Charge of Construction)

Quoted hereunder-pertinent portions of Sec. 202, R.A. 7160, which provides;

*It shall also be the duty of all persons, natural or juridical, owning or administering real property,
including the improvements therein, within the city or municipality, or their duly authorized
representative, to prepare, or cause to be prepared , and file with the xxx, city xx xxx assessor, a
sworn statement declaring the true value of their real property, whether previously declared or
undeclared, taxable or exempt, which shall be
the current and fair market value of the property, as determined by the declarant. Such declaration shall
contain a description of the property sufficient in detail to enable the assessor or his deputy to identify
the same for assessment purposes.