Republika ng Pilipinas

LALAWIGAN NG RIZAL

Road A Phase IV COGEO Village, Barangay Bagong Nayon, Antipolo City 1870 Rizal, Philippines
 barangay_bagongnayon@yahoo.com   647-0942   942-0358   bagongnayon.antipolo@gmail.com
www.facebook.com/BagongNayonOfficialPage   www.antipolo.ph

KP PORMULARYO BLG. 7

USAPING BARANGAY BLG. ___________

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NAGSUSUMBONG
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(Tirahan)

LABAN KAY / KINA: UKOL / PARA sa:

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IPINAGSUSUMBONG
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Barangay Bagong Nayon,Antipolo City
(Tirahan)

SUMBONG
AKO / KAMI AY NAGSUSUMBONG LABAN SA MGA TAONG BINABANGGIT SA ITAAS
DAHIL SA PAGLABAG SA AKING / AMING KARAPATAN AT KAPAKANAN AYON SA
SUMUSUNOD NA MGA PARAAN:
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DAHIL DITO, AKO / KAMI AY MAGALANG NA HUMIHILING NA INYONG
IPAGKALOOB SA AKIN/AMIN ANG NARARAPAT AYON SA BATAS O KATWIRAN KATULAD
NG MGA SUMUSUNOD:
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GINAWA NGAYONG IKA-________ NG _____________, 20__.

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PANGALAN AT LAGDA
NG NAGSUSUMBONG

INIHAIN AT TINANGGAP NGAYONG IKA-________ NG _____________, 20__.

KGG. LARRY T. ONZA

Lupon Chairman/Punong Barangay
Barangay Bagong Nayon: Kabalikat sa Kaunlaran at Pagbabago ng Lungsod ng Antipolo.