Republic of the Philippines

Province of Surigao Del Norte

Municipality of Dapa
Barangay, Sta. Fe

OFFICE OF THE PUNONG BARANGA

CERTIFICATION OF RESIDENCY

TO WHOM IT MAY CONCERN;

This is to certify that ____________________Filipino citizen, is a bona fide resident of

purok ___, Barangay________, Dapa, Surigao Del Norte is personally known to me and to the
best of my knowledge and belief of good moral character and law abiding in the community.

This certificate that he/she had never been accused any pending criminal case what so
ever to detrimental of the state as per available record to the Barangay.

This certification is being issued upon the request ___________________ whatever legal
purposes it may serve him/her best.

Issued this _____________at the office of the Punong Barangay of Barangay Sta. Fe,
Dapa, Surigao Del Norte Philippines.

____________________
Signature of Application
CC# ________
OR# __________
DATE ________
AMOUNT: ___

Hon. EMMANUEL E. IJAPON

Punong Barangay