Republic of the Philippines

Department of the Interior and Local Government

PHILIPPINE NATIONAL POLICE
MAKATI POLICE DISTRICT
Station 9

CERTIFICATION OF LEGALLY, PEACEFULLY AND ORDERLY

EXECUTION OF SEARCH WARRANT:

TO WHOM IT MAY CONCERN:

THIS IS TO CERTIFY that elements of _________________________________

stationed at Camp Crame, Quezon City, have today _________________,
200__conducted Search and Seizure in my residence/premises located at
______________________________________, _____________ by virtue of Search
Warrant No.________ issued by Honorable Judge
________________________________,Executive/ Presiding Judge of Branch ______,
RTC, ____________________ dated ___________________:

That during the course of their search, they found and recovered the following
personal properties of mine which is the subject of the Search Warrant, to wit;
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
____________________

I FURTHER CERTIFY that the search was done in peaceful, appropriate and
orderly manner and nothing were taken by the searching party aside from those
enumerated above.
_________________________
(Signature over printed name of owner)

SIGNED IN THE PRESENCE OF:

1.) ______________________________ 2.) _______________________________

(Signature over printed name) (Signature over printed name)

SEARCHING PARTY/TEAM LEADER:

____________________________________
Signature over printed name)

SUBSCRIBED AND SWORN to before me this ____ day of

____________20___
at___________________________________________________,
______________________.

____________________________
(Administering Officer)