Republic of the Philippines

Province of Agusan del Norte

Municipality of Kitcharao
BARANGAY CANAWAY

OFFICE OF THE PUNONG BARANGAY

TO WHOM IT MAY CONCERN:

This is to certify that ANNIE ROSE DELACERNA, Filipino citizen, with

live-in-partner, at legal age and a resident of Purok 4 Barangay Canaway, Kitcharao,
Agusan del Norte.

Certify further that the person stated above presently residing at the
address stated above.

This certification is being issued upon request of the interested person

concern for vaccination purposes.

Issued this 21st day of January, 2022 at the Office of the Punong Barangay
of Barangay Canaway, Kitcharao, Agusan del Norte, Philippines.

CHARLEMIN P. MORALES
Punong Barangay

Issued on : January 21, 2022

Issued at : Brgy. Canaway, Kit. A.D.N.