Date: ____________________

To Whom This May Concern:

I have the honor to authorize _____________________________

to purchase medicines/groceries in my behalf.

MA. ADELFA D. FUELLAS

Senior Citizen

Date: ____________________

To Whom This May Concern:

I have the honor to authorize _____________________________

to purchase medicines/groceries in my behalf.

MA. ADELFA D. FUELLAS

Senior Citizen