Application For CLOA Cancellation (Portion of Lot)

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Republic of the Philippines

DEPARTMENT OF AGRARIAN REFORM


Province of Batangas
Region No. IV-A

CANC APPLICATION No.__________________________

APPLICATION FOR CANCELLATION

I/We, Spouses PEDRO CRUZ and ANA CRUZ, both Filipino, of legal age, residents of 123
Emerald Street, Pearl Subdivision, Parañaque City, do hereby apply for the cancellation of the
title/s in accordance with DAR Administrative Order (AO) No. 2, Series of 2018, as amended,
describe as follows:

REGISTRY
EP/CLOA NO. AREA REGISTERED
OF DEEDS LOCATION
TITLE NO. (sqm.) OWNER/S
(ROD)
Pinagkawitan,
CLOA No. 0012345 Province of 4,345 of
Adelina F. Mata Lipa City,
TCT No. T-222 Batangas 7,000
Batangas

The aforesaid application for cancellation of title/s is based upon any of the following: (Please
check appropriate box)

1 X Existence of a final and executory (FINEX) judgement with following information:


.

Docket No. : A-0123-1234-2019


Case Title: DAR Clearance for the Transferrability of Lands Awarded to
ARB pusuant to PD No. 27/RA No. 6657 as impl. by DAR AO
8, S. of 1995
Name of Parties:    Adelina F. Mata (Seller)/ Spouses Pedro Cruz and Ana Cruz
(Buyers)
Office/Court: Department of Agrarian Reform
Date of Decision: 2019
Date of Finality: 4/12/2020

2 Correction of technical description in the aforesaid title/s which do not affect


.

the identity or number of agrarian reform beneficiaries or the size and scope of the
landholdings under the said title/s.
3 Transfer of title/s on the basis of a conveyance approves through a valid DAR
Transfer clearance.

4 Motion of the petitioner/s or all the parties to withdraw the Cancellation Action.
.

Hereto attached are the required document/s to support the processing of my/our application/s:
(Please check appropriate box)

ð Certified true copy/ies of the subject EP/CLOA/other title issued not later than six (6)
months before the filing of the application/s
ð Certified True Copy of the Decision of the court/office
ð Certification from the court/ office that the Judgement has become final and executory
ð Motion to Dismiss or Withdraw in Case No. _____________ pending at
________________ docketed as ______________________
ð DAR Transfer Clearance issued by the Regional Directory (RD)
ð Corrected Technical Description of the subject EP/CLOA/other title issued under agrarian
reform program certified as true and corrected by the DENR-LMS/LRA
ð Proof of service that the registered owner/s of the EP/CLOA/other titles and the Registry of
Deeds (ROD) were served with a copy of the Cancellation Form No. 1

I/We hereby certify under oath that all statements I/We made in this application are true and
correct based on my/our personal knowledge and that all documents attached are authentic.

Signature/s over Printed Name/s of Applicant/Owner

PEDRO CRUZ ANA CRUZ


Driver’s License No. XXXXX Driver’s License No. XXXXX
Date:____________________ Date:____________________

SUBSCRIBED AND SWORN to before me this __________________ in Pateros, Metro


Manila, Philippines, the above named applicant/s presented to me their competent evidence of
identity.

WITNESS my hand and seal on the date and at the place above stated.

Doc. No    :
Page No.    :
Book No.    :
Series of 2021.

Copy Furnished:     
Register of Deeds
116 Balintawak Road, Lipa City, 4218 Batangas

Adelina F. Mata
ARB/ Registered Owner of CLOA
Pinagkawitan, Lipa City, Batangas

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