LAV Form No. 02 - Republie of the Philippines - COMMISSION ON ELECTIONS Committee on Local Absentee Voting May 9, 2016 NATIONAL AND LOCAL ELECTIONS LIST OF APPLICANTS FOR LOCAL ABSENTEE VOTING OFFICE/UNIT/STATION: ADDRESS: SEQ — PLAGE OF REGISTRATION : 2 F DATE OF MUNICIPALITY) PLACE OF NO LAST NAME, _FIRST NAME ___MIDDLENAME SIRE sarancay | rryyoisrmict | PROVINCE | assiGnMent | 1SEQ. NO LAST NAME FIRST NAME. MIDDLE NAME DATE OF BIRTH PLACE OF REGISTRATION. PRECINCT # BARANGAY MUNICIPALITY] CITY/DISTRICT PROVINCE PLACEOF _ ASSIGNMENT w 21SEQ, PLACE OF REGISTRATION itor 7 DATEOF | PRECINCT MUNICIPALITY/ * NO LAST NAME FIRST NAME MIDDLE NAME Sar f Barancay | Cyry/pisraicr | _ PROVINCE ASSIGNMENT CERTIFICATION This is to certify that herein applicants are bona fide members/employees of with office address at This is to further certify that the above-named applicants will be assigned on electiondayoutside the place where they are registered votersto perform election-related duties or due to the performance of their functions in covering and reporting on the elections. cal SUBSCRIBED AND SWORN to before me this (Signature cbove printed name) day of 2016, at Philippines. (Signatureabove printed name ) Officer Authorized to Administer Oath