Republic of the Philippines

Province of Bohol
Municipality of Valencia
Barangay Adlawan

OFFICE OF THE BARANGAY CAPTAIN

BARANGAY CLEARANCE

To Whom It May Concern:

This is to certify that MR./MRS. ____________________________________, _____ years of age,

married/single, is cleared from all the obligations of this barangay, he/she has no
derogatory records and that he/she has paid whatever liabilities he/she incurred as a
resident of this barangay.

This clearance is issued upon request of the above named person for
_______________________________________.

Issued this _______ day of ______________________ 2015 at the office of the Barangay
Captain at Adlawan, Valencia, Bohol.

HON. MAXILINDO T. MAGAN

Barangay Captain

Paid Under O.R. # ___________________

Issued at Adlawan, Valencia, Bohol
Amount Paid P 50.00