Republic of the Philippines

Department of Justice
LAND REGISTRATION AUTHORITY
Registrar of Deeds of

IN RE: IN THE MATTER OF

ADMINISTRATIVE RECONSTI-
TUTION OF THE ORIGINAL
COPY OF THE ORIGINAL/
TRANSFER CERTIFICATE OF
TITLE NO/S. .

IN THE REGISTRY OF DEEDS OF

LRA Case No.

Petitioner.
x---------------------------------------------------------x

PETITION
COMES NOW PETITIONER and before this
Reconstituting Officer thru the Register of Deeds, respectfully states
that:

1. The petitioner is of legal age, Filipino, married and a

resident of
.

2. The petitioner is the registered owner/co-

owner/transferee/mortgagee of a parcel of land covered by
and described in the Original/Transfer Certificates of Title
Nos. of the Registry of Deeds of .

3. The original of the aforesaid Original/Transfer Certificates of

Title on file with the Registry of Deeds of was
lost or destroyed due to .

4. The following documents are hereby submitted in support of

this petition, to wit:
 4.1. Owner’s Duplicate Certificate of Title and three (3)
Xerox copies thereof, (if the owner’s duplicate has been
lost/destroyed/or is not available, then the co-owner’s
duplicate certificate of title and three (3) Xerox copies
thereof should be submitted).

4.2. Real Estate Tax Receipts representing full payment of

at least two (2) years prior to the filing of the petition;

4.3. Three (3) Xerox copies of the latest Tax Declaration;

4.4. Others.

PRAYER

WHEREFOR, premises considered, it is respectfully prayed that

the original of Original/Transfer Certificates of Title Nos.
lost or destroyed in the files of the said Registry of Deeds be
ordered reconstituted on the basis of the owner’s/co-owner’s duplicate
certificate of title and in accordance with Republic Act No. 6732.

(place and date)

VERIFICATION

, after having been duly sworn to in

accordance with law, depose and say; that he/she is petitioner; that
he/she caused the preparation of the foregoing petition; that he/she has
read the contents and the facts stated herein are true and correct to
his/her knowledge.

Affiant

SUBSCRIBED AND SWORN TO before me this day of

20 , affiant exhibited to me his/her Community Tax Certificate
No. issued on 20 at
Philippines.

Notary Public
Doc. No.
Page No.
Book No.
Series of