Notarial Register of Atty.

______________________
Under Appointment No. _______ made on January __, 2014 of the Regional Trial Court of _______ for the year 2014 and 201 and e!piring on "e#em$er %1, 201 .

Doc. No 1

Nature of Document

Name of Person Executing, Swearing, or Acknowledging

Witnesses to t e Signature

Date

!om"etent E#idence of $dentity

Remarks

*age No. ___1____ +oo) No. ___1____

&ere$y #ertify that during the pa't (ee)' _____ in'trument (a' e!e#uted $efore me. _______________________ _______________________