Republic of the Philippines

COMMISSION ON ELECTIONS
Manila

CERTIFICATE ~r; ~ntfttt~":;'~~

INSTRUCTIONS: (Readwell before mling up this form.) ,,,>

Filethis in FIVE (5) LEGIBLEcopies. "

I
1.
2. File this certificate of candidacy with the Law Department, COMELEC Main Office, Intramuros, Manila, starting November 20, 2009 up to
midnight of November30, 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 ncrrsnaron shall be accepted,
4. Titles such as 'Dr., Atty., Don, Ginoo,Senor, Datu, Hadji, Sultan, Bai, Senora, Kapitan or similar titles are expressly prohibited.
5. This certificate shall be sworn before a notary public or any official authorized to administer oath. COMELEC officials are not authorized to
administeroath.
"'L ",oj' ;.~.
h'li~{~ I -., '.:.' ~ • .' • -, ~ ::~~;':: '!l~l'0·
J:l~:.,er~f!y.?nm~un(;emy.c:an4idllcy for thQ PO$itj(l11~t:$,E~ATOR,Republic ~f ~Ile pl\iUppines, In the May 10. 201~,~r!!!·~.~t~.nSi
~~¥~.~~~r
h~Vi~9been sworn to in accordance with law, hereb~.~~!e tbe following:. .. ':: 'r.:~~'~~~,.

1. MY NAME IS : 3. MY GENDER IS : 4. MY AGE IS:"

1.1 last Name :?·~·.·;~'-.:~·.:~I".T;_·:·.-.r.·r.-:r.-.r.-.l-.·_l·.-.T·. -_[-_-_1:-_Y-__T: I: ::_: -_l-_-_r-.T_ -_T::: .~-..;.'?'.;.'

/-5-'-'~=~=D:...:-:_I:-O-F=O==B"':R_e:_:_I:-s-:4-';'· ?..,;..;.;'
~ ...,;..
,;. ';";''';''-4

1.2 first Name :~>'-l~'-.f;'-.~·.1.~T'-_T".·f'.:.-._X.-._:._._.1::

-'- 1:-_T: .: : __r-- :::::~::[:-_t'_ '1:'_ I'_I: -.: : ~:[i-[p._:i._:-[ (9:F~-:
1.3 f-1iddleName _ -_; :j __I'- ::::r:-_
>.- ;~':.;;:'-~_t~[:'
[~.1.~ ::-.:
J::;-_:::-:-_:::._:_::l:-.:::'.:-_
-_:::--__: Month
6. MY PLACE OF BIRTH IS :
Day Year

2. I AM GENERALLY OR POPULARLY KNOWN BY THE NICKNAME OR STAGENAME

'Indicate only one nickname or stagename) City/Mun _ !i:.1ff':/!!4t _. .. .
•• ~ ••• - "," - -r _. ,-- .,. - -r- - -~ - - ~ - - ~ - - ~-. -:- --:- - -:. - ~- --,- - -~- - ~ -- -:- --:- - -;- - -~ - -: -- ~- - -:---;- --:

Province NCI{ __. _.__. _. __.. ' . _._._

: A- : o :fl.: I jJ :1'1 : :::: ::: : :
~ ~_--.:.-~--.'-_-_-'-~-.-_:-~'_'_--_.'_--.-.".--.~.-_-:_-_-_:-.- ..'_--_-·.--_-.c_.-_:_._- ..·-.-_-~.-.--_'-.-.' .. -..'-.--- ..----.'-.--.'--.-.:- ... .'-.-.- ..-- .. -18.MYCIVILSTATUSIS:
7. I AM OFFICIALLY
. _.. _.
NOMINATED
ANb
BY: (Attach Certificateof Nomination)
k.llflTJJfW.t:I. _ftlf!.ry. . . ._-_----._---_--
D Single D Widow/er

Political Pa § Manied D LegallySeparated

9. />tY RESIDENCE!
ADDRESS IS:
Q.2 City/Nunicipality
9.1 Province
l~:~::?_:::::~:-::::·::::::::[::;:::::::::::;:::::::::;::.:::::
9.3 8arangay
DAnnUl1ed

Full Name of Spouse,

I Divorced
if. married

:-~;~:~.: ~~-~-:-~-:---:~:
, .. , ... '...
~-h':i-:---:'--:.--;--: :·~:-O-~-:-o:'~i:---:ii:i:-j- -:~-:-flT-S-: . _M"tJ~/):1.1{J7?I_ J):__((<f.t?/II. __. _.
! .. .' - .. t ••• ' •• _ ~ • _ ; __ : _ •• : ••• :••• '; •• '; •• ; •• -' : ••• : : ••• :•• _ ; • _ .:. __ ", __ ~ __ ~ __ ~ __ .: __ .:. __ :. __ ' ••• : 10. MY PROFESSION OR
_

;Wf- if ~;o-:~Ti -fA": ~: lifT -':Jj::- -~iA-if FiT il-f -- iJiiviikiii ~Li-'d r -!
9.4 HouseNo.1Street I Subdivision OCCUPATION IS :

J - _/;FtW'l:tP..,_<JD.vgjfftlJ({[.d~p$vmrn. __ VfKHn7

11. MY POST OFFICE ADDRESS FOR ELECTION PURPOSES IS : (Couldbe the sameas No.9) 12. I AM A REGISTERED VOTER OF
Precinct
- .. _-.-_4! q-3 _-_.-
~ - --
13_ MY PERIOD OF RESIDENCE IN THEPHIUPPINES BEFORE MAY 10, 2010 IS :
Bgy __ I-:l?~_QJ:-fi_ If tJ V. fJJ!__._. _
~:c. . ... _. _
'~I :0 :J.: No.of Months
r--'---.
: c;/f: No.of Years
City/Mun

Province __ Ne" . .. ..
~-----------------------------------------------------------4
14. I AM A NATURAL BORN FILIPINO CmZEN.
15. I AM NOT A PERMANENT RESIDENT OF, OR IMMIGRANT TO, A FOREIGN
COUNTRY.
16. I AM ELIGIBLE FOR'THE OFFICE I SEEK TO BE ELECTED TO.
17.'1 WILL SUPPORT AND DEFEND THE CONSTITUTION OF THE REPU.B.LIC OF THE
PHILIPPINES AND WILL MAINTAIN TRUE FAITH AND ALLEGIANCE THERETO. I
WILL OBEY THE LAWS, LEGAL ORDERS AND DECREES PROMULGATED BY THE
DULY CONSTITUTED AUTHORITIES, I IMPOSE THIS OBLIGATION UPON MYSELF
VOLUNTARILY, WITHOUT MENTAL RESERVATION OR PURPOSE,9F EVASION.

Thumbprint

1 hereby certify that the facts stated herein are tru~we-~on~ge.

. ,,' t1J2J!?il{l\l t? . dJ.roN

Signature of Candidate Over Printed Name

SUBSCRIBED AND SWORN to before me tt,ls

- N OV ') 0
~2blOb'fa November, 200~ijY
OATH.
OF SAN ~~ant
"
exhibiting to me hi
~Identification Card No. l,,11!1t • M -:-IH!Ilfn Issued by : LtD QP/)'~ On: D'l.. Mal'- J4S/v

Doc. No. _-, . .c;35&=-"IL-_~

Page No. _-,-J$=- __ ~
Book No. __ -,,:ll.,",- __ :ed to Administer Oath)
Series of 200~