DAR … DACE FORM

CLEARANCE 3.03.0…
FORM

Republic of the Philippines )

Municipality of Barili ) S.S.
Province of Cebu )

AFFIDAVIT OF TRANSFEREE

I, ______________________________, Filipino, of legal age, married/single, with

residence and postal address at ________Malolos, Barili, Cebu_______, after having sworn
according to law, hereby depose and say:

1. That I own a total aggregate landholding of _____________ square

meters/hectares including the area of __________________ square
meters/hectares, more or less, that I am acquiring from ___SPS. CRISANTO__
__PABROA SR._and FELIPA MAG-USARA PABROA____, under Doc. No. _2_;
Page No. _2_; Book No. _XXX_; Series of _2005_; of Notary Public Atty.
__Joselito Troy G. Suello___ dated __February 3, 2005__; and,

2. That this affidavit is executed in compliance with DAR Administrative Order No.
1, Series of 1989, as well as to show proof that my total aggregate landholding
inclusive of the land subject of the abovementioned transaction does not
exceed five (5) hectares.

AFFIANT SAYETH NONE:

_________City of Cebu___________________
(Place)
______________________________________
(Date)

___________________________________
Affiant
(Signature over printed name)

SUBSCRIBED AND SWORN to before me this ______ day of __________________,

20______ at ______________________ affiant exhibited his/her ID/Community Tax Certificate
No. _______________ issued at ___________________ on ______________, 20______.

Doc No. _______;

Page No._______;
Book No._______; NOTARY PUBLIC
Series of 2018.

To be filed at the local DAR Municipal Office in the place where the land subject of the transaction is located.