Katarungang Pambarangay Form No.

Republic of the Philippines

Province of _______________
City / Municipality of _______
Barangay _________________

OFFICE OF THE PUNONG BARANGAY

_______________________
Date

LIST OF APPOINTED LUPON MEMBERS

Listed hereunder are the duly appointed members of the Lupong

Tagapamayapa in this Barangay who shall serve upon taking their oath
of office and until a new lupon is constituted on the third year following
their appointment.

1. ________________________ 11. ________________________

2. ________________________
3. ________________________
4. ________________________
5. ________________________
6. ________________________
7. ________________________
8. ________________________
9. ________________________
10. ________________________
12. ________________________
13. ________________________
14. ________________________
15. ________________________
16. ________________________
17. ________________________
18. ________________________
19. ________________________
20. ________________________

_______________________
Punong Barangay
ATTESTED:
__________________________
Barangay / Lupon Secretary

IMPORTANT: This list shall be posted in three (3) conspicuous

places in the
barangay for the duration of the terms of those named
above.

WARNING: Tearing or defacing this notice shall be subject to

punishment
According to law.