PROPERTY INDEX NO. _____________________ RPA Form No. ___ TAX DECLARATION NO.

____________________ DECLARATION OF REAL PROPERTY (FILED UNDER REPUBLIC ACT NO. 7160)
Owner

Address
Administrator

Address

DESCRIPTION AND OTHER PARTICULARS OF PROPERTY s IMPORTANT: Issued for taxation purposes and should not be considered as title to the property.
Location of property __________________________________________________________________________________
Number and Street (Barangay/District) (Municipality/City/Province)

Certificate of Title No. __________________ Cadastral Lot No. ________________ Assessors Lot No. _________________ Boundaries North_______________________________________ South____________________________________________ East________________________________________ West____________________________________________
(State streets, lots, or streams by which bounded or names of owners of adjoining lands)

I (a) LAND (AGRICULTURAL/MINERAL)

Kind OWNERS DECLERATION Area Value Kind Area ASSESSORS FINDINGS Class Unit Values Market Values

Total

Total Total Adjusted Market Value

I (b) PLANT &TREES

OWNERS DECLERATION Number and Annual Product Kind (Quality) Value Base Market Value 100% Adjustments: (a) Along or no rd. frontage ______% (b)______Kms. to all weather rd. ______% (c)______Kms. to market (pob) ______% Total Adjustment ______% Total Total Adjusted Market Value ASSESSORS FINDINGS Number and Annual Product Kind (Quality) Unit Value Market Value

Total

II LAND (RESIDENTIAL, COMMERCIAL, INDUSTRIAL, SPECIAL)

Kind OWNERS DECLERATION Area Value Kind Area ASSESSORS FINDINGS Unit Value Adjustments Market Value

Total

Total

III (a) BUILDING AND OTHER IMPROVEMENTS

DESCRIPTION Floor Area 1. OWNERS DECLERATION Construction Materials st nd rd 1 Storey 2 Storey 3 Storey Market Value Roof

Total DESCRIPTION Floor Area 2. ASSESSORS FINDINGS Construction Materials st nd rd 1 Storey 2 Storey 3 Storey

Market Value Roof

Total III (b) MACHINERY 1. OWNERS DECLERATION j Date of Operation Original Cost

Date of OpDESCRIPTION

Depreciation

Market Value

Total Date of Op DESCRIPTION 2. ASSESSORS FINDINGS j Date of Operation Original Cost Depreciation

Market Value

Total

SWORN STATEMENT OF OWNER Under the provision of Republic Act No. 7160, I HEREBY CERTIFY that current and fair market value (x) of the foregoing described property of which I am the owner/administrator, is to the best of my knowledge and belief, as follows: Land _______________________________________ __________________ Improvements _______________________________ __________________ TOTAL VALUE _________________________ __________________
(Signature)

TIN_________________________ Subscribed and sworn to before me this _______ day of __________________________ the __________ person taking oath presenting Community Tax Certificate No. ______________________ issued on ____________________ ___________ at ________________________________________
(x) State in the nearest multiple of 10 as 950 instead of 948; 1,000 instead 1,004. Signature of official administering oath Official Title

TIN________________________
ASSESSMENT BY Kind of Property Actual Use (CITY/PROVINCIAL ASSESSOR (BOARD OF ASSESSMENT APPEALS (CENTRAL BOARD OF ASSESSMENT APPEALS Market Value Assessment Level % % % % Total Total TOTAL ASSESSED VALUE__________________________________________________________________________________________
(Amount in words) APPROVED: Provincial/City Assessor By DATE Provincial/City Assessor Deputy

Assessed Value

THIS DECLARATION CANCELS TAX NOS. _________________________________________________: IS CANCELLED BY TAX NOS._____________________________________ TAX UNDER THIS DECLARATION BEGINS WITH THE YEAR ___________CEASES WITH THE YEAR ____________ENTEREDIN THE REAL PROPERTY ASSESSMENT RCLL FOR ________ BY _________ PREVIOUS OWNER ____________________________________________________________ PREVIOUS ASSESSED VALUE: LAND ______________________
IMPROVEMENT ________________________________