I, , of legal age, and with postal address at (Citizenship) (Civil Status)

after having duly sworn to in accordance with law hereby depose and say:

1. That I am the _________________________________ of the following real properties, (lands, buildings, machineries

or other improvements) located in the city/municipality of _______________________, province of _______________________owned by ________________________________________________ of which the description and true current and fair market

(State Name of Owner/s if filed by administrative or authorized representative

value/s are as follows:

A. LAND (Residential, Commercial, Industrial, Agricultural, Special)LotNo.

B. BUILDING AND OTHER STRUCTURES

in (Sq.M.)

C. MACHINERIES

OTHER IMPROVEMENTS (Perennial Trees/Plants)

2. That I am executing this sworn statement in compliance with Republic Act No. 7160

IN WITNESS WHEREOF, I have hereunto affixed my signature this ____ day of ___________, ______ at __________,if thumbmarks require signatures of two (2) witnesses:

TIN

SUBSCRIBED AND SWORN to before me this ____ day of ___________, 20___, affiant exhibiting his/her CommunityTax Certificate No. A-_____________ issued on _____________ at _________________, Philippines.

TINNote:

1) Include in this sworn statement only real property owned or administered by the affiant in one municipality or city.2) Prepare three (3) copies and after having been subscribed to by the affiant, submit the same to the Provincial, City, Municipal Assessor or

Municipal Deputy Assessor or Ex-Officio Deputy Assessor of the province, city or municipality where the property is located; the original andduplicate to be retained by receiving office and the triplicate to be returened to the affiant after receipt thereof has been duly acknowledged.

3) Write "NEW" under column "Existing Tax Dec. No." for property not previously declared.4) Original acquisition cost of Machinery include such costs as freight and insurance charges, brokerage, arrastre and handling, custom duties and

taxes, cost of inland transportation and handling.5) Write additional information in another sheet, if necessary.

Existing Tax Dec. No.

(Taxable or Exempt)

ExistingTax Dec. No.

BlockNo.

Cadastral/PLS No.

TotalFloor Area

Dist./Barangay)

No. Storey

Actual Use

and FairMarket Value

Title

Year

Occupied

General Description Completed/

Ha./Sq.M.Area Location of Property

(St./Dist./Barangay)

Location of Property (No./St./

Owner of Lot Where Bldg. is Located

Total Current andFair Market Value

Classification(Res.,Agr.,Com.,etc.)

True Current

Existing Tax Dec. No.

Location of True CurrentProperty (No./St./ and FairDist./Barangay) Market Value

Value of Depreciation

Cost ofInstallationCommenced

OperationAcquired

Site

OriginalAcquisition

Cost

SWORN STATEMENT INDEX NO.

SWORN STATEMENT OF THE TRUE CURRENT AND FAIR MARKET VALUE OF REAL PROPERTIES

(Required under Section 202/203 of Republic Act No. 7160)

(Owner or Administrator or Authorized Representative)

No. of Trees/ Hec./ Productive

True Current and Fair Market Value

Productive Non-Productive

DescriptionDate

(Signature of Administering Officer)

Signature(Witness) (Witness)

Annual Product per Tree/Plant

No. of Trees/Hec. & Ages

Non-Productive

Existing Tax Dec. No.

Kinds of Trees/Plants

Sheet1

SWORN STATEMENT INDEX NO.

SWORN STATEMENT OF THE TRUE CURRENT AND FAIR MARKET VALUE OF REAL PROPERTIES

(Taxable or Exempt)

(Required under Section 202/203 of Republic Act No. 7160)

I,, of legal age,and with postal address at

(Citizenship) (Civil Status)

after having duly sworn to in accordance with law hereby depose and say:

1.That I am the _________________________________of the following real properties, (lands, buildings, machineries

(Owner or Administrator or Authorized Representative)

or other improvements) located in the city/municipality of _______________________, province of _______________________

owned by ________________________________________________ of which the description and true current and fair market

(State Name of Owner/s if filed by administrative or authorized representative

value/s are as follows:

A. LAND (Residential, Commercial, Industrial, Agricultural, Special)

ExistingLotBlockCadastral/TitleAreaClassificationLocation of PropertyTotal Current and

Tax Dec. No.No.No.PLS No.Ha./Sq.M.(Res.,Agr.,Com.,etc.)(St./Dist./Barangay)Fair Market Value

B. BUILDING AND OTHER STRUCTURES

Existing Tax Dec. No.TotalNo. StoreyGeneral DescriptionYearActual UseOwner of Lot Where Bldg. is LocatedLocation ofTrue Current

Floor AreaCompleted/Property (No./St./and Fair

in (Sq.M.)OccupiedDist./Barangay)Market Value

C. MACHINERIES

Existing Tax Dec. No.DateOriginalCost ofValue of DepreciationLocation ofTrue Current

DescriptionAcquiredCommencedAcquisitionInstallationProperty (No./St./and Fair

OperationCostSiteDist./Barangay)Market Value

OTHER IMPROVEMENTS (Perennial Trees/Plants)

Existing Tax Dec. No.Kinds of Trees/PlantsNo. of Trees/ Hec./ ProductiveAnnual Product per Tree/PlantNo. of Trees/True Current and Fair Market Value

Hec. & AgesProductiveNon-Productive

Non-Productive

2.That I am executing this sworn statement in compliance with Republic Act No. 7160

IN WITNESS WHEREOF, I have hereunto affixed my signature this ____ day of ___________, ______ at __________,

if thumbmarks require signatures of two (2) witnesses:

Signature

(Witness)(Witness)TIN

SUBSCRIBED AND SWORN to before me this ____ day of ___________, 20___, affiant exhibiting his/her Community

Tax Certificate No. A-_____________ issued on _____________ at _________________, Philippines.

(Signature of Administering Officer)

TIN

Note:

1)Include in this sworn statement only real property owned or administered by the affiant in one municipality or city.

2)Prepare three (3) copies and after having been subscribed to by the affiant, submit the same to the Provincial, City, Municipal Assessor or

Municipal Deputy Assessor or Ex-Officio Deputy Assessor of the province, city or municipality where the property is located; the original and

duplicate to be retained by receiving office and the triplicate to be returened to the affiant after receipt thereof has been duly acknowledged.

3)Write "NEW" under column "Existing Tax Dec. No." for property not previously declared.

4)Original acquisition cost of Machinery include such costs as freight and insurance charges, brokerage, arrastre and handling, custom duties and

taxes, cost of inland transportation and handling.

5)Write additional information in another sheet, if necessary.

Sheet2

Sheet3