Republic of the Philippines

COMMISSION ON ELECTIONS
Manila

INSTRUCTIONS: (Read well before filling up this rorm.) .

1. File this in FIVE (5) LEGIBLECaples. .' . . .....
2.. File this certificate .of candidacy with the Law Department, COMEt;EC Main Office,' Intramuros, Manila, starting November 20, 2009 up to
midnight of November 30, 2009.' . '. .
3. Attach to this certlricate the Certificate of Party Nomination unless yQU are an independent candidate. After midnight of November 30, 20Q9, no
certificate of nomination shall be accepted. . .
4 .. lltJes such as 'Dr., Atty., Don, Glnoo, Sefior, Datu, Hadjl, Sultan, Bal;;Senora, Kapitan or similar titles are expressly prohibited.
5. This certificate shall be sworn before a notary public or any offjcl~1authorized to administer oath. CO'-1E;LECcfflcials are not authorlzed to
administer oath. /, .

3. MY GENDER IS :

1.1 Last Name :5rc';p'!i~(ff'OrT"r'[''''j''''[''T''T""T'r'T''T'T''r--rr'rTT''i

, •• ,J ••••••••• , ••• J •••• , •••• ' •••• , ••• J ••••••••• '•••• , ••••• __ ., ••• J ••••••••• , ••• J •••• , •• ,., ••• ,' •••• , •••• , •••• '••• ,' •• "
,01'1ale DFemale.
5. MY DATE OF BIRTH
.. ... "~
IS :
.....

1.2 'First Name [f:j;'ltfo'-!;:neriTl-roi"'rTT"T"-i"'r'T'''l~'-f'''l''T''i''''f"T"T"';

~;;:::::::~::;:~::;:~:::~;;:::;:::~::::~::.:~::::~:::;:::~.-_._-_-~ -.-_-.-_.~'; -_._-.~-_-_-..-,~_-_-_-_~-_-_-_~.-.-_-_+_-_-_-~-....-_.)/_--- ~-.---_-~-_-----.~-.---_~
:,:,.·L:·f,'.' ,,).'.'1,._:,: ~.·.'.l,o,·.-,:,:
~_ .'7. _
-r- f:'!.·-.:,:q-.,:.·~.·,·,T~.'.~:,
_ _ ?' r]
1.3 Middle NameW iO !0!Lieir!6"i j 1·; 1 l 1 i j Ii i i i j1 ! ! i Month, Day' Year'
2. I AM GENERAi.iYOR·poPUl.AR~y'i{NOwN·B:Y;;':H~'Nlci~NAM'~'al~·STAGENA'M'e·'
....' ..·, ~;ty~~u~LACE'%I1pIr IS ;
(Indicate only one nickname or stagename) .' Province ::::::f.:(lii-lI~A:::::::::::::::::::
~~~~~~J=I=~=I=~~l=~~I=~=I=i~I~~~~=~~I==~[=~~[=~~[==~[~J~==~~[==~C=~~[~=~[=J~=~J=~~J==~I~=~l=~~
8.Mya~L~M~~:

" " " ~". o 0

I AM OFFICIALLY N0;INATED BY: (Atta~ Certitlcate or Nomlnationp, . Single wtoow/er
': ,.~~,0.P~ ",..,.!..~, (Jc!.f!:?
PoliticalPar
~-:2 [Zl Married· 0 Legally Separated.
9. MY RESIDENCE!
ADDRESS IS: 9.1 Province
o
[~:~l~~~:r.:::r::]::~I:::r::T::]:::L:r:}:::I~~]:~j~~~1:::1~::l:::j Annulled f Divorced

f~:\9·~~~1':!C~r~'!f··T''']''·T''·l''T-TT·T''T'''1·9·r-,l?r;~1~~''(f''T''l'--r''rT''l''-r-TT'r~l
:HJ-':t-l: l:~J\ : : ; ; : : ; : ; :\:.0).\:,l):0:: : : : : : -: : ;
!0~~;~~~~~~~~
..~.'?t:f."J[~
10, MY PROFESSION OR
• ~",'- • .,. ••••• _ .~J _. _.1.__.J ~__ ._' •• _ .'- p', l. __.'-. __, _. _ .I •• _ .L._.J ~•••• '. .1.. ~ .,. __ J. __ .l. '. '_••• J. _." t '. _. _L._ •.•• _• ..!

9 -,it House No.1 Street I Subdivision . . .. . OCCUPATION IS: -

f4rO]j'["'i0roi"~'TO'!';:ifi1sr'isTf]"p-)(i~Tfi"'T"r'T"TT"j--'r"T---i"'!"] ..
~ .'._ •••• _. __ ~ •••• __ ~.: __ ••••• _ "'. __ ,' ~ I.. __ ~ .L __ • .J. __ •••.' •• ". __ .L. __ •••• _ • .J. __ .J .L __ .-'., __L .} __ ••••.• _ .". __ .t.. __ .' ,'". _~._~
t~j~ .._,., , .
11. MY POST OFFICE ADDRESS FOR ELECTION PURPOSES IS : (COdrdbe th~ same as No.9) 12. I AM A REGISTERED VQTER OF

p. __ .. - - - - -
40..2. HO(2-,ONe> $'p ·JO/--.{/?o MA--ill...f\ Precinct
. Jr' OI~06
· .. ·;r.;.· ?'n.·· ·.., ·
'2
00... '0. .". OM ••• _. __ 0 __ • ~ .0 _0 _ ._. '0 0 0 • "I~_ • __ • •• • __ -. --

Bgy <t'1- I..-oK Id

13, MY PERIOD OF RESIDENCE IN THE PHILIPPINES BEFORE MA'tihO, 201.0 IS: .•. " ;;: ' ';.;:":;1" _ ;.;..' r"'" '."
J2(!.!6,0, __~ ..}1t:':0.!~,
..
[~Ijl No. of Months [iI~ No. of Year~
City/Mun
Province

14. I AM A NATURAL BORN FIUPINO Ol1ZEN. -

: .' -;R.Oii~bTHUMdPrU~T.
" .' ,. ,
'
•• I AM NOT A PERMANENT RESIDENT OF, OR IMMIGRANT TO/A FOREIGN.
COUNTRY. .
16. I AM ELIGIBLE FORTHE OFFICE 1 SEEI< TO BE ELECTED TO.
17. I WILL SUPPORT AND DEFEND THE CONSTITUTION OF THe REPUBLIC.OF THE
PHIllPPINES AND WILL MAINTAIN TRUE FAITH AND ALLEQrANCETHERETO. I
WILL OBEY THE LAVVS, LEGAL ORDERS AND DREES PRdMULGATEO BY THE
DULY CONSTITUTED AUTHORITIES. 1 IMPOSE HIS OBllGA'WroN UPON MYSELF
VOLUNTARILY, WITHOUT MENTAL RESERVA ON OR PURPO§E OF EVASION.

I hereby certify that the facts stated herem are true and correct of my q!Nn personal knowledge .
. bAt-t
Signatllre
t1 N <:""(7'0
of Candidate ov~f,Printed
e~ Name
0 ~ pD

O;ATl-1 ,
SUBSCRIBED AND SWORN to bef9n:i,Ole. this ~day of Novernber, 2009, at -PAC--1G ~ T affia~hibitir=,9 to me his/her
CTC/ldentlfication Card No. 2'" - C'j - IJ I~ (~ Issued by : M L -yo On: .Q.5s--.:S d4JYI .
Doc. No, '12-
Page No. 2.0
Book No.. t (Officer Authorized to Administer Oat
Series of 20oq.

•......•.....
..--'W'"IERWIN N. IU~A
NOTARY.PUBLIC
UNTIL DECEMBER 31, 20 to
APPOINTMENT NO. t6Ll (2009-2011))
ROLL NO. 5£1471
iBP NO. LRN 06670 I RIIAL
PTR NO. 002 Cf5 58/'5-l?q.·O~ lMAV An