REPUBLIC OF THE PHILIPPINES)

PROVINCE OF OCCIDENTAL MINDORO) S.S

MUNICIPALITY OF SABLAYAN)

DEED OF DONATION OF FIREARMS

KNOW ALL MEN BY THESE PRESENTS:

This DEED OF DONATION OF FIREARM is hereby entered into between and

amongst:

PO2 Amie Fallaria Bulaqueña of legal age, Filipino Citizen, and a resident of Brgy
Inzo Arnaldo Village, Roxas City, Philippines, herein referred to us DONOR:

and

PO1 Randy Fallaria Bulaqueña of legal age, Filipino Citizen, and a resident of
Brgy Inzo Arnaldo Village, Roxas City, Philippines,
Herein referred to us DONEE.

WITNESSETH

That the donor is the absolute and registered owner of:

KIND : pistol
MAKE : GLOCK 17
CALIBER : 9mm
SERIAL No : HPL 199
License No :

That for and in consideration in the trust, fidelity, help, love and affection
shown upon the DONOR by the DONEE as her younger brother, and as an act of
gratitude on her part, the DONOR hereby donate: (1 unit GLOCK 17 with serial
number: HPL 199) and voluntary give to the DONEE;

That the DONEE hereby accepts and receives her donation made in favor by
the DONOR and hereby manifest his gratefulness for the latter’s generosity and
liberality.

IN WITNESS WHEREOF, the parties hereby set their hands this ____ of
March, 2012, Philippines.

PO2 Amie F Bulaqueña PO1 Randy F Bulaqueña

DONOR DONEE

SIGNED IN THE PRESENCE OF:

SPO4 Emilio D Lara PO3 Antonio B Buenvenida

Witness Witness
REPUBLIC OF THE PHILIPPINES)
PROVINCE OF OCCIDENTAL MINDORO) S.S
MUNICIPALITY OF SABLAYAN)

BEFORE ME, this day of March 2012 in the City of Roxas, Philippines, PO2
Amie Fallaria Bulaqueña personally appeared before me with Res. Cert. No.
__________________issued at Roxas City on and PO1 Randy
Fallaria Bulaqueña with Res. Cert. No_____________________ issued at Roxas City
on ________________ . Both known to me to be known and to be the same persons
who executed the foregoing instruments and they acknowledged before me the
same is free and voluntary act and deed swore under oath to be truth thereof.

WITNESS MY HAND AND SEAL, on the date and place first above written.

Doc.No. _______________:
Page No. ______________ :
Book No. ______________:
Series of _______________:
REPUBLIC OF THE PHILIPPINES)
PROVINCE OF OCCIDENTAL MINDORO) S.S
MUNICIPALITY OF SABLAYAN)

AFFIDAVIT OF TRANSFER

I, PO2 Amie Fallaria Bulaqueña, Filipino, of legal age, single, and a resident of
Brgy, Inzo Arnaldo Village, Roxas City, Capiz, after having been sworn to in
accordance with law, do hereby depose and say;

1. That I am a bonafide holder of a licensed firearm known as GLOCK 17

caliber pistol with serial number HPL199;

2. That I am, waving all my rights over the said firearm in favor of PO1
Randy Fallaria Bulaqueña, of legal age, single, and a resident of Brgy, Inzo
Arnaldo Village, Roxas City, Capiz,

3. That I am, executing this Affidavit for the purpose of establishing the
foregoing facts.

IN WITNESS WHEREOF, I have hereunto affixed my hand this ____th day of

March 2012 at Roxas City, Capiz.

PO2 Amie F Bulaqueña PO1 Randy F Bulaqueña

DONOR DONEE

Subscribed and Sworn to this day of _______________________ at

__________________________, Philippines, the affiant/s showing to his/her
competent proof of identity CTC/ID
No.____________________________________________, respectively, issued
on___________________________________valid until __________________________.
 Republic of the Philippines
HEADQUARTERS PHILIPPINE NATIONAL POLICE
Camp Crame, Quezon City

APPLICATION FOR SPECIAL PERMIT

THE CHIEF OF THE PHILIPPINE NATIONAL POLICE

Camp Crame, Quezon City

15 March 2012
(Date)

Sir,

I have the honor to request that a Special Permit under the provisions of
Section 879 of Revised Administrative Code and General Orders nos. 7, 7 - A and
7 - B be issued to PO1 Randy Fallaria Bulaqueña, 25 years old and employee of
the Philippine National Police for the following described firearms and
ammunition:

FIREARMs and AMMUNITION

KIND MAKES CALIBER SERIAL No. QUALITY
Pistol Glock 17 9MM HPL 199

I Hereby certify that the above described arm (s) (is, are) necessesary for the
personal protection of PO1 Randy F Bulaqueña in the performance of his official
duty and for his personal protection from enemy while rendering official duties.

I further certify that I will cause PO1 Randy F Bulaqueña to surrender said
permit and firearms to the Chief of the Philippine National Police when said
firearm (is, are) no longer necessary for his personal protection in the performance
of his official duties.

I also promise that in case he loses or fails in the manner to account for the
arm, I will cause his to pay a fine of P40.00 for each arm, or if he resigns, or is
separated from the salary or any money due to his pay a fine of P40.00 for each
arm, or if he resigns or is separated from the salary or any money due to his
produce the receipt from the Chief of Philippine National Police showing that his
firearm (has, have) been deposited or Certificate of the Property Officer of her
Office stating that the Government firearm (has, have) been duly accounted for in
accordance with Executive Order 186, dated February 11, 1939.

AND I FURTHER PROMISE to notify the Chief of Philippine National Police

in case of his change of station.

SALVADOR S DAGOON JR, PESE

Police Superintendent
Chief of Police
(Director/Head of Office/Commanding Officer)