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Revised Form Per

Local Government Code 1991


(R.A. 7160)

PERSONAL CANVASS

PURPOSE: For generator use

ITEM NO. QUANTITY ARTICLES AND DESCRIPTION UNIT PRICE

1 2 cont crude oil

Signature of Dealer or
Dealer

(Date)

We hereby certify that we have personally canvassed the prices of the above
items.

EUNICE G. TIBUDAN AIDA O. DOMINGUEZ JEROME M. PADRONES


Municipal Aaccountant BAC Chairman Municipal Treasurer

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