Republic of the Philippines I

CO:MNIISSION ON I~LECTlONS
Mauila I
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INSTRUCTIONS: (Read well before filling up this form.) . ~ V I ).' .
1. FIle tliis in AVE (5) LEGIBLEcopies. T!!'1E:;...-:.-- .
2. File this certificate of candidacy with -the Law Department. 'COiJitl~Off+.;e,.I-R-\f.<>ffi.U+.os,...M
midnight of November 30, 2009_ .
3. Attach to this certificate the Certificate of Party Nomination unless you are an independent candidate. After midnight of November 30, 2009, no
certificate of nomination shall be accepted. .
4. TItles such as 'Dr., Atty." Don, (iinoo, Senor, Datu, Hadji, Sultan, Bel, Senora, Kapitan or"similar titles are expressly prohibited.
5. This certificate shall be sworn before a notary publlc or any official authorized to administer oath. COMELEC officials are not authortzed to
admlnlster oath.

1.1 Last Name

5. MY DATE Of BXRTH,IS :
L2 First Name
t~_fiH.i.i.!-)-Ih-f_tij
Month D.y
1.3 Middle Name

2.:;: Mil GENERAlLY OR POPULARLY KNOWN BY THE NICKNAME ORSTAGENAME

(indica,e only one nickname or stagename)
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-.' - • ," •• , •• ~ ••.• - • -.' - •••

. . . . : : . . . . , : : ::
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- -.- • -.- • - • - • , •••

9. MY m;srOf.;NCE[
9.1 Province
ADDitESS IS l

T<.~:t~:~~::.
I_~:~'T.-:~I: T::r:.-:_·:J::I: .• l!]~ :i~I<l~ l:~]·.~i:~r:
g.2Cjty/~lunlcipality 9_3 Barangay . . Full Name of Spouse, if married

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l--~jl~~JlM&yl:P~ttOE:FESS;J- ..:.-'--...;....-4
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9,4 House No./ Street / Subdivision OCCUPATION IS':
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'~-i;'h:iiji-:-eTi[ --;--:--:--:---;--':--~.-: ..b.a~!~.fiS1...WDMM __..... -_.-.-.. -
111. MY POST OFFICE ADDRESS FOR ELECTION Pl1RPOSES IS: (Couldhe the same as No.9) 1:Z. !AM A REGlSTERED.VOTER OF
Precinct

Bgy
13. t-nr PERIOD OF RESIDENCE IN THE PHIUPPXNES BEFORE MAY 10,2010 IS :
City/Hun
No. ct veera

14-. I Atvl A NATURAL BORN AUPINO CITIZEN.

15. !AM NOT A PERMANENT RESIDENT OF, OR IMMIGRANT TO, A FOREIGN
COUNTRY.
16. lAM EUGlBLE FOR THE OFFICE I SEEK TO BE ELECTED roo
D. I WILL SUPPORT AND DEFEND THE CONSTITUTION OF THE REPUBLIC OF THE
PHILIPPINES AND WILL MAINTAIN TRUE FAITH AND ALLEGIANCE THERETO_ I

.
WILL OBEY THE LAWS, LEGAL ORDERS AND DE:CRcES PROMULGATED BY THE
DULY CONSTITUTED. AUTHORITIES_ I IMPOSE THIS OBLIGATION UPON MYSELF
VOLUNTARILY, WITHOUT MENTAL RESERVATION OR PURPOSE OF EVASION.

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Tlnrmbprfnt

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. . Sfgnature of/Candlda'"e Over Printed Nene

1
,r ~rJC. OATH Ah
SUBSCRIBED AN,!?,SWORJIIllto·b4re me this L day.of ~' 2009, at l4'e. , affiant exhibiting to me his/her
. crCfIdenUfjcation Card No. . ~., ~ {J-+ e~sued by : ~ . on ; f?- 1...
e>q .
Doc. No. LfS 1. ;
Page No.--!f--~
BOOK No_ I : (Omcer Authorilctl to Admioi.ster Oath) ~
Series of 20o_. !\l T1[. ~:;Lt.\efE:NGE V. 6~HlI'J T L
N!}T4.iiY PUBl.1C
'./NT It. lJ'':'CEMCi:H
3J '20'0'1 I

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