Hon. Alfonso M. Llopis Donor Certificate of Acceptance: Brgy. Secretary

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DEED OF DONATION

KNOW ALL MEN BY THESE PRESENTS:

This Deed of Donation made and executed by HON. ALFONSO M. LLOPIS herein
represented by its office staff MR. ERWIN G. BANGALAN with office address at Capitol Hills,
Tuguegarao City, herein after called the DONOR;

-In favor of-


The MAGSAYSAY, LASAM, CAGAYAN and CENTRO WEST, ALLACAPAN, CAGAYAN and
CAPALALLIAN, PAMPLONA, CAGAYAN herein represented by BRGY. SECRETARY LIBRITO D.
PASCUAL and BRGY. SECRETARY REYNA DOLORES B. LADDARAN and BRGY. CAPTAIN
CONRADO A. FERNANDEZ herein after called the DONEE.

WITHNESSETH
That for and in consideration of a desire to contribute a share for the immediate improvement
of the Barangays particularly in the 2nd District of Cagayan, the DONOR has freely and
voluntarily given, transferred and conveyed be way of donation (PHOTOCOPIER MACHINES) to
the DONEE, its successors and assigns free and clear of any and all liens and encumbrances
whatsoever all its rights, interest and title on:

MAGSAYSAY, LASAM, CAGAYAN


CENTRO WEST, ALLACAPAN, CAGAYAN
CAPALALLIAN, PAMPLONA, CAGAYAN

With a total amount of (____________________)

IN WITNESS WHEREOF, the DONOR has hereto subscribed herself/himself this ____day of _________.

HON. ALFONSO M. LLOPIS


Board Member, 2nd District Cagayan
DONOR

CERTIFICATE OF ACCEPTANCE

The DONEE, for and in behalf of the Barangays, hereby accepts and acknowledges the donation
from The MAGSAYSAY, LASAM, CAGAYAN and CENTRO WEST, ALLACAPAN, CAGAYAN and
CAPALALLIAN, PAMPLONA, CAGAYAN and express their most sincere appreciation for the
benevolence shown by the DONOR.

IN WITNESS WHEREOF, The DONEE has set his hands this _____of PACAC, ALLACAPAN,
CAGAYAN and LUZON, CLAVERIA, CAGAYAN.

LIBRITO D. PASCUAL
Brgy. Secretary

REYNA DOLORES B. LADDARAN


Brgy. Secretary

CONRADO A. FERNANDEZ
Brgy. Captain
SIGNED IN THE PRESENCE OF:

ROMAR B. PALATTAO SAMSON CATOLOS


(Signature over Printed Name) (Signature over Printed Name)

ACKNOWLEDGEMENT
REPUBLIC OF THE PHILIPPINES
( (SS.
BEFORE ME this (date) , personally appeared to me with
CTC# issued on at
CTC# issued on at

Known to me and known to be the same person who executed the foregoing instrument, and they
acknowledge to me that the same is free and voluntary act and deed, including that of the entities that
they represent.

This instrument refer to a deed of donation and certificate of Acceptance that consist of one page,
including this acknowledgement is written, and which is signed by the parties concerned and each and
every page thereof.

WITNESS MY HAND AND NOTARIAL SEAL, on the date at the place first written above.
Doc .No. NOTARY PUBLIC
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