REPUBLIC OF THE PHILIPPINES

(Municipality)

BARANGAY CLEARANCE

TO WHOM IT MAY CONCERN

This is to certify that (na! "# $u%in!%%) owned and operated

by (na! "# "&n!' %"&in in *TI '!i%t'ati"n) with business
address located at ($u%in!%% a++'!%%) , after complying with the
requirements prescribed by this Office, is hereby issued a BARANGAY
!"ARAN" for the purpose of securing a #ayor$s %ermit in order to
operate a (natu'! "# $u%in!%%) in accordance with the
Barangay Re&enue Ordinance of '(()* +owe&er, the Barangay
learance may be cancelled or re&oed anytime if public safety
and interest so require*

This Barangay learance is hereby issued upon request of

-requestor.

/ssued this 000 day of -month. , -year.*

HON, (BRGY
CHAIRMAN)
Punong Barangay