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REPUBLIC OF THE PHILIPPINES

PROVINCE OF CEBU
MUNICIPALITY OF _________________
BARANGAY ________________

______________________
DATE

RANNIE CORAZON P. GRAVADOR, MD, FPSMS


OIC-Provincial Health Officer II
Cebu Provincial Health Office

Dear Sir/Ma’am:

Submitted herewith is the list of Barangay ______________ of Barangay _______________, Municipality of _________________, Cebu to wit:

NO. FAMILY NAME FIRST NAME MIDDLE NAME EXTENSION BIRTHDAY AGE SEX DATE CONTACT
NAME APPOINTED NUMBER
1
2
3
4
5
6
7
8
9
10

Prepared by: Approved by:

_________________________ ________________________
Barangay Secretary Barangay Captain
Cellphone No. _____________ Cellphone No. ____________

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