RPTA FORM NO.

4-2004 ATTACHMENT 4

TAX DECLARATION OF REAL PROPERTY

TD/ARP No. ___________________________ PROPERTY INDEX NO. _______________________

Owner: _____________________________________________________________________________
Address: ________________________________________________ Telephone No.: ____________
Administrator/Beneficial User: ___________________________________________________________
Address: ________________________________________________ Telephone No.: _____________
Location of Property: _________________________________________________________________
(Number and Street ) (Batangas/District) (Municipality and Province/City)

OCT/TCT: ______________________________ Survey: _______________________________

CCT/CLOA: ____________________________ Lot No.: _______________________________
Dated: ________________________________ Blk. No.: ______________________________

Boundaries:
North: ____________________________ South: ____________________________
East: ____________________________ West: ____________________________
________________________________________________________________________________________________

KIND OF PROPERTY ASSESSED:

LAND MACHINERY
Brief Description: _________________
BUILDING: Others:
No. of Storeys: __________ Specify: ________________________
Brief Description: ________

Classification Area Market Value Actual Use Assessment Level Assessed Value
___________ ____ Php ______________ __________ _______________% Php___________
___________ ____ ______________ __________ _______________% ___________
___________ ____ ______________ __________ _______________% ___________
___________ ____ ______________ __________ _______________% ___________
Total: ______________ ___________

Total Assessed Value _________________________________________________________________

(Amount in Words)

Taxable Exempt Effectivity of Assessment/Reassessment: ______ ______

Qrt. Yr.

Approved By: _________________________________________________________ ____________

Prov’l/City/Municipal Assessor Date

This declaration cancels TD/ARP No. ________ Owner: ____________ Previous A.V. ___________

Previous PIN:

Notes: This declaration shall serve as notice to the above mentioned declarant in pursuance of Section 223 of R.A. 77160, otherwise known as
the Local Government Code of 191, for which the due process provision on real property assessment under Section 226 of the said Code
may be availed of .

This declaration is also for real property taxation purposes only and the valuation indicated herein are based on the schedule of unit
market values prepared for the purpose and duly enacted an Oridnance by the Sangguniang Panlungsod under Ordinance No. 402 series
of 2018 dated July 19, 2018. It does not and cannot by itself alone conferred any ownership or legal title to the property.