Pormulariong Panghukuman Blg. 143 Page No. ____ Book No.

____
NOTARIAL REGISTER of ATTY. _______________________
Rehistro Notaryal ni G.
Under appointment made on the _______________________
Sa nombramiento na ginawa noong ________________
of _______________________, Philippines, for the year
ng ________________________________Pilipinas, para sa taon
and expiring December 31, 201__
na magtatapos sa Disyembre 31,

ENTRY TITLE/DESCRIPTION NAME & ADDRESSES NAME & ADDRESSES COMPETENT EVIDENCE DATE & TIME OF TYPE OF FEES OTHER PLACE OF
NUMBER OF INSTRUMENT OF PARTIES OF WITNESSES OF IDENTITY NOTARIZATION NOTARIAL NOTARIZATION OTHER
ACT THAN OFFICE OF NOTARY
PUBLIC AND/OR REMARKS

21 Sworn Declaration of EARL P. VILLANUEVA N/A Voter’s ID 4215-0018A- April 13, 2018 Jurat
Gross receipts/sales Labo Airport, Ozamiz 111192EPV10000
City

22 Certificate of Candidacy DEA B. BODIONGAN N/A Passport No. EC4014072 Apil 16, 2018 Jurat
Centro Napu, Tudela,

23 Certificate of Candidacy JIMMY D. SIAY N/A Voter’s ID VIN 4216-0074A- April 17, 2018 Jurat
Pan-ay Diot, Tudela, Mis B0558JDS10000

24 Special power of Attorney FR. VICTOR SERINO N/A Philhealth Card No. April 17, 2018 Acknowledgme
ABP. MARTIN S. 14050026893-6 nt
JUMOAD
Catadman, Ozamiz City

25 Sworn Declaration of LOURDES B. SUMATRA N/A Driver’s License April 18, 2018 Jurat
Gross receipts/sales Hulpa, Tudela, mis.Occ. K04-90-019878

executed
isinagawa

HEREBY CERTIFY that during the past week ______ instrument were sworn to before me
Pinatunayan na noong nakaraang linggo ______ ang mga kasulatan pinanumpaan sa harapam ko
______
acknowledge
tinanggap
DATE ___________________________________________ ____________________
Petsa Notary Public
Whether acknowledgement, oath, jurat, signature witnessing or copy certification Notaryo Publiko