REPUBLIC OF THE PHILIPPINES

PROVINCE OF CAGAYAN
MUNICIPALITY OF DALUPIRI ISLAND

OFFICE OF THE MUNICIPAL HEALTH OFFICER

26 June 2002
(date)

MEDICO-LEGAL CERTIFICATE

TO WHOM IT MAY CONCERN:

This is to certify that Mrs. May Samurai, 39 years old, F/married, a resident of Brgy
Kataltalonan, Dalupiri Island, Cagayan Province has been attended in office on 26 June 26, 2002
at 10:00 A.M. for

* abrasion zygoma
* due to fighting incident
* on 25 June 2002 at about 5PM in Brgy. Kataltalonan, Dalupiri Island, Cagayan Province.

REMARKS:

These injuries will require medical attendance for a period of less than nine (9) days
unless complications or other manifestation due to internal injuries were not apparent at the time
of examination set in.

(SGD) DR CALO SUGAN, M.D.

Municipal Health Officer
Lic. No. 0000001

N.B.

A mark, erasure or alteration of any entry invalidates this certification.

Paid Under G.R. No. 0123456

Issued at Dalupiri Island, Cagayan Province
On 26 June 2002