REPUBLIC OF THE PHILIPPINES

CITY OF DAVAO

BARANGAY SAN ANTONIO

AGDAO DISTRICT DAVAO CITY

LIST OF OWNERS AND RENTERS INFORMATION DATA

OWNERS

NAME OF HUSBAND __________________________________________________________AGE__________ WORK______________

NAME OF WIFE________________________________________________________________AGE__________ WORK______________

CHILDREN
NAME ______________________________________________ AGE ___________ WORK______________________
NAME ______________________________________________ AGE ___________ WORK______________________
NAME ______________________________________________ AGE ___________ WORK______________________

HOUSE ADDRESS ________________________________________________________________________________________________

HOUSE PARKING AREA/GARAGE (YES) OR (NO) IF YES, HOW MANY CARS CAN IT ACCOMMODATE ______

RELATIVES
NAME ______________________________________________ AGE ___________ WORK______________________
NAME ______________________________________________ AGE ___________ WORK______________________
NAME ______________________________________________ AGE ___________ WORK______________________

BORDERS
NAME ______________________________________________ AGE ___________ WORK______________________
NAME ______________________________________________ AGE ___________ WORK______________________
NAME ______________________________________________ AGE ___________ WORK______________________
NAME ______________________________________________ AGE ___________ WORK______________________
NAME ______________________________________________ AGE ___________ WORK______________________
NAME ______________________________________________ AGE ___________ WORK______________________
NAME ______________________________________________ AGE ___________ WORK______________________
NAME ______________________________________________ AGE ___________ WORK______________________
NAME ______________________________________________ AGE ___________ WORK______________________
NAME ______________________________________________ AGE ___________ WORK______________________
NAME ______________________________________________ AGE ___________ WORK______________________
NAME ______________________________________________ AGE ___________ WORK______________________
NAME ______________________________________________ AGE ___________ WORK______________________
NAME ______________________________________________ AGE ___________ WORK______________________
NAME ______________________________________________ AGE ___________ WORK______________________
NAME ______________________________________________ AGE ___________ WORK______________________
NAME ______________________________________________ AGE ___________ WORK______________________
NAME ______________________________________________ AGE ___________ WORK______________________
NAME ______________________________________________ AGE ___________ WORK______________________
NAME ______________________________________________ AGE ___________ WORK______________________
NAME ______________________________________________ AGE ___________ WORK______________________
NAME ______________________________________________ AGE ___________ WORK______________________
NAME ______________________________________________ AGE ___________ WORK______________________
NAME ______________________________________________ AGE ___________ WORK______________________
NAME ______________________________________________ AGE ___________ WORK______________________

PREPARED BY: RECEIVED BY:

__________________________ ____________________________
JUNNY C. TAGALOG BARANGAY SECRETARY
PUROK LEADER