Judicial Form No.

143, as amended
Pormulariong Panghukuman Blg. 143
Page No. ____ Book No. ____
NOTARIAL REGISTER of ATTY. _______________________ of _______________________, Philippines, for the
year
Rehistro Notaryal ni G. ng ________________________________Pilipinas, para sa
taon
Under appointment made on the _______________________ and expiring December 31, 201__
Sa nombramiento na ginawa noong ________________ na magtatapos sa Disyembre 31,

ENTRY TITLE/DESCRIPTION NAME & ADDRESSES NAME & ADDRESSES COMPETENT EVIDENCE DATE & TIME OF TYPE OF
NUMBER OF INSTRUMENT OF PARTIES OF WITNESSES OF IDENTITY NOTARIZATION NOTARIAL
ACT

1 AFFIDAVIT OF LOSS Archbishop Martin S. N/A Senior Citizen’s April 9, 2018 Jurat
Jumoad I.D./Personally known
Catadman, Ozam.
2 Employee’s Data Change Fr. Ernesto O. Colanag N/A Clergy ID/Personally known April 9. 2018 Jurat
Request (SSS)
Catadman,Ozam.
3 Motor vehicle Accident Fr. Ronald Ruben Julian Suarez Driver’s License No. April 11, 2019 Jurat
Report Catadman, Ozam. Nino Mark Miravilla k0403000758
Catadman, Ozam.

4 Deed of Absolute Sale Fr. Celestino C. Palma Julian Suarez CTC CC1201413357945 April 11, 2018 Acknowledgme
Lourdes Gomez nt
Fr. Arnold Daplin
Catadman, Ozamiz City
Catadman, ozamiz City

5 Declaration of Gross Jerson Anonat n/a SSS ID No. 1009123851 April 13, 2018 Jurat
Receipts Lam-an, Ozamiz City
 executed

isinagawa

HEREBY CERTIFY that during the past week ______ instrument were sworn to
before me
Pinatunayan na noong nakaraang linggo ______ ang mga kasulatan
pinanumpaan sa harapam ko
______

acknowledge

tinanggap
DATE ___________________________________________
____________________
Petsa
Notary Public

Whether acknowledgement, oath, jurat, signature witnessing or copy certification

Notaryo Publiko