Republic of the Philippines

Department of Environment and Natural Resources

NATIONAL CAPITAL REGION

APPLICATION FOR RESIDENTIAL FREE

PATENT
Application No.:
___________

_________________________________ Entry No.:

Name of Applicant: _EUGENIO B.

DOMONDON_________________________________
Mailing Address of Applicant:169 Blk. 6, Pili Ave., West Rembo,
Makati City______
Citizenship:
FILIPINO_______________
_MARRIED__
Sex: _MALE_____

Civil Status:

Age: _70______ IFMINOR, name of guardian:

_________N/A_______________
Date of Birth: December 25, 1945,
Union_____________

Place of Birth: Agoo, La

Name of Spouse:
AURELIA M.
DOMONDON__________________________________
Contact Nos:
_____________________________________________________________
Location of residential land applied for:
No./Street
Minicipality/City
169 PILI STREET____
CITY___________

Barangay
WEST REMBO___________ MAKATI

Description of residential land applied for:

Lot #
Area(Sq.M.)

Block #

Survey#

_35728-B___
BLOCK 60ORIG. SURV. Psu2031/Surveyed:1909_
___54 (Sq.M.
Applicants predecessor-in-interest (if Any):
_________________________________
Date of entry by applicant or predecessor-in-interest upon the
residential land applied for (on or about)
____________________________________.
I declare, under the penalties of perjury, that my total
land holdings are not more than 12 hectares that this
application has been made in good faith and to the best of my
knowledge all information contained herein are true and
correct.

Republic of the Philippines

Department of Environment and Natural Resources
NATIONAL CAPITAL REGION
EUGENIO B. DOMONDON
Applicants Name and
Signature
CTC/I.D. No.:

OSCA I.D.

No. 06942
Issued On:Feb. 08, 2006
Issued At: Makati City

SUBSCRIBED AND SWORN TO before me this ________ day of

____________ at ______________________________________.