THE OFFICER-IN-CHARGE

MUNICIPAL AGRARIAN REFORM OFFICER

DUMAGUETE CITY

S I R/M A D A M:

The undersigned would like to request from your good office for the issuance of DAR
CLEARANCE, involving Lot No.______, covered under Transfer Certificate of Title No.
_____________ situated in _______, of which I am the Vendee of said parcel of land by virtue of a
“DEED OF EXTRAJUDICIAL SETTLEMENT OF ESTATE AND SALE OF PORTION
OF AN UNDIVIDED SHARE OF A PARCEL OF LAND “, duly notarized and registered
under Doc. No. ________, Page No. _________, Book No. _______, Series of 20_____, in the
notarial registry of Atty. ______________________________, Dated ______ day of
___________________, 20____ in the City of _________.

Thank you.

Very truly yours,

________________
Vendee