LTC Form No.

Republic of the Philippines ) LTC Application No. ________

Province of Davao del Norte ) S.S.
City of Panabo )

APPLICATION FOR ISSUANCE OF LAND TRANSFER CLEARANCE

We, CECILIA BARRIENTOS GABRILLO , of legal age, Filipino citizen, married and resident of Davao City,
Davao del Sur, Philippines, after being sworn in accordance with law, hereby depose and state;

1. That I, CECILIA BARRIENTOS GABRILLO is the HEIR/WIFE of VICENTE M. GABRILLO , registered

owner of a that parcel of land, identified ( Lot No. 1067-B, ( LRC ) Psd-241659 ) being a portion of
Lot 1067, Cad-283, situated in the Barrio of Limbaan, Municipality of New Corella, Province of
Davao del Norte, , Island of Mindanao. Containing an area of FORTY THOUSAND TWO ( 40,002 ) SQ. M.
more or less. Covered by Transfer Certificate of Title No. T-42618;

2. This Application for the issuance 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 the 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 :

O Official Receipt and Electronic Copy of the Title : Annex ____

O Deed or document to be registered : Annex ____
O Affidavit of Aggregate Land Holding : Annex ____
O Affidavit of Retention, Non-Tenancy/Tenancy with : Annex ____
Compliance of tenant’s right of Pre-emption and / or
Redemption and no pending case before the regular
Courts or any other tribunal involving the land subject of the
Transaction, if there is a case before the regular courts or any
Other tribunal the same had been decided with finality
O Municipal Assessor’s Certificate of Aggregate Landholding : Annex ____
O City Assessor’s Certificate of Aggregate Landholding : Annex ____
O Provincial Assessor’s Certificate of Aggregate Landholding : Annex ____

3.2 FOR THE TRANSFERRE :

O Affidavit of Aggregate Land Holding : Annex ____

O Municipal Assessors Certificate of Aggregate Landholding : Annex ____
O City Assessors Certificate of Aggregate Landholding : Annex ____
O Provincial Assessors Certificate of Aggregate Landholding : Annex ____
O Municipal Agrarian Reform Program Officer
Certification ( LTC Form No. 2 ) : Annex ____

4. Having submitted/attached hereof the mandatory documents as required under DAR A.O. No. ____,
Series of 2020, I/We hereby file this instant application/request to facilitate the issuance of the
corresponding Certificate on LTC.

IN WITNESS WHEREOF, I have hereunto set our hands this ____day of ________________. 2023 at
Panabo City, Davao del Norte, Philippines.

CECILIA BARRIENTOS GABRILLO

Vendee
Applicant
ID No.
Date Issued :
Place Issued:

SUBSCRIBED AND SWORN to before me this __________________________day of 2023 at, Panabo City,
Davao del Norte, Philippines . Affiants upon exhibiting to me their duly issued government IDs with details stated above.

Doc. No.

Book No.

Page No.

Series of 2023

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