Republic of the Philippines

Province of Antique
Municipality of Tobias Fornier
Barangay Fatima
OFFICE OF THE PUNONG BARANGAY

CERTIFICATION

TO WHOM IT MAY CONCERN:

This is to certify that the livestock owned by

_______________________ __________________whose data and facsimile
appears below from this Barangay and the said livestock is not stolen

This is to certify that fees pertaining to the Barangay regarding

sale of said livestock or transport same outside been fully paid.

KIND:________________________ COLOR:___ _______________

AGE:__________________________ SEX: _______________________

ADDRESS:_______________________________________________ ____

JUSTINA J. PELINGON
Punong Barangay

ATTESTED:

AMY E. RUBIANO
Barangay Secretary

Paid under O.R No. _____________

Tobias Fornier, Antique
Date Issue: _____________