Republic of the Philippines

Province of Samar
Municipality of Sta. Margarita
Barangay INORAGUIAO

BARANGAY CLEARANCE

TO WHOM IT MAY CONCERN:

THIS IS TO CERTIFY that ____________________________________ a resident of

Barangay INORAGUIAO, Sta. Margarita, Samar, who is personally known to me to be a
law-abiding citizen with good moral character. That of my own personal knowledge has not
committed nor been involved in any kind of unlawful activities in this Barangay.

This Certification is being issued upon request of the interested party for any legal
purposes it may serve.

Issued this _____ day of _________________, 20 at Barangay INORAGUIAO

Sta. Margarita, Samar.

NELIA A. DESCALLAR
Punong Barangay
____________________________
Signature of person being cleared

Records Verified by:

PRESILDA S. RAOLA
Barangay Secretary

Comm. Tax, Cert. No.______________

Issued at: ________________________
Issued on: _______________________