RSS Form 2-B

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RSS Form No.

2-B
Department of Agrarian Reform Provincial Office
Province of MASBATE

REQUISITION FOR SURVEY SERVICES INVOLVING SUBDIVISION OF COLLECTIVE CLOAs

Municipality RSS No. 2-B Date:


TITLE/TAX PROGRAM ESTIMATED
MODE OF AREA
NAME OF LANDOWNER(s) DECLARATION LOCATION/BARANGAY LAND NUMBER REMARKS/ACTION TAKEN
ACQUISITION (Has.)
NUMBER CATEGORY OF LOTS

CERTIFICATIONS
VALID CODES
I hereby certify that the above-mentioned landholdings are fully documented per attached checklist
and have not been subjected to same type of survey as now requested. MODE OF ACQUISITION PROGRAM LAND CATEGORY
1. CA 7. Settlement 1. Private Agricultural Land
2. VOS 8. KKK/GOL 2. Operation Land Transfer
DATE (PRINTED NAME AND SIGNATURE) 3. OLT/PD 27 3. Gov't Owned lands
Municipal Agrarian Reform Officer 4. E.O. 407/448 4. E.O. 407/448
5. VLT/DPS
I hereby certify that the above-mentioned landholdings have been properly evaluated. 6. Landed Estate

DATE (PRINTED NAME AND SIGNATURE)


Provincial Agrarian Reform Officer

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