CARPER LAD Form No. 9 Manifestation to Apply Petition for Exemption Exclusion Clearance or File Petition Protest From CARP Cov

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CARPER LAD Form No. 9 (New) Republic of the Philippines

DEPARTMENT OF AGRARIAN REFORM MANIFESTATION TO APPLY/PETITION FOR EXCLUSION/EXEMPTION OR TO FILE PROTEST OF CARP COVERAGE  ___________________  ___________________  

Date

The Honora!e Se"re#ar$ De%ar#men# o& A'rar(an Re&orm D(!(man) *+e,on C(#$ hru: ________________________ _________________________ _ Provincial !grarian Reform "#cer $$ %ir: &a' $e manifest our inten*on to appl'pe**on for +,-/%$"N+,+&P$"N or F$+ PR"+% on -!RP -overage for the following parcel of land sub0ect of No*ce of -overage (N"-) dated  ____________________:  ____________________: itle itle No. (if an'): an'):

_____ ________ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ _____ _____ ______ ______ ______ ____ _

a1 Decl Declar ara* a*on on::

____ ______ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ___ _

Name of and "wners:

(Famil' Name2 First Name2 &iddle Name)  _______________________  ___________________________________ ________________________ __________________ ______  _______________________  ___________________________________ ________________________ __________________ ______  _______________________  ___________________________________ ________________________ __________________ ______  _______________________  ___________________________________ ________________________ __________________ ______  _______________________  ___________________________________ ________________________ __________________ ______  _______________________  ___________________________________ ________________________ __________________ ______

!rea in hectares:

_______________________ ___________________________________ ________________________ __________________ ______

oca*on: (&unicipalit'2 (&unicipalit'2 3aranga') 3aranga')  _______________________  ___________________________________ ________________________ __________________ ______ $n support of this applica*on2 $we will submit the necessar' informa*on and recordsdocuments re4uired under D!R per*nent guidelines on the ma5er within thirt' (67) da's from the date of the N"- for protest on coverage and si1t' (87) da's from the date of N"- for e1clusione1emp e1clusione1emp*on. *on. $t is understood that m' failure to submit the documentar' re4uirements within the prescribed period shall be construed as m'our waiver thereat.

9er' trul' 'ours2

Name o& Lan-oner/

S('na#+re

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A+#hor(,e- Re%reen#a01e (Famil' Name2 First Name2 &iddle $ni*al)

A--re

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Duplicate "riginal

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riplicate

= D!RP"

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