Republic of the Philippines

Province of La Union
Municipality of Caba
BARANGAY URAYONG

OFFICE OF THE PUNONG BARANGAY

Name:___________________________________________
Address:_________________________________________
Gender:______Age:_____Civil Status:________________

BARANGAY CLEARANCE
TO WHOM IT MAY CONCERN,
This is to certify that the above-named person whose signature and SANGGUNIANG BARANGAY

HON.SAMUEL R.CAMACHO
thumbmarks appear below is a bonafide resident of this Barangay.
PUNONG BARANGAY

It is further certified that he/she is a law-abiding citizen and not

FEDERICO J. ABASOLO
BARANGAY KAGAWAD
known to be a member of any subversive organization or fugitive from
MARIA ELENA L. BAUTISTA
Justice and has no pending case filed against him/her per records now BARANGAY KAGAWAD

available in our Barangay Office as of this date. LOIZAM P. DELA CRUZ

BARANGAY KAGAWAD

This certification is being issued upon the request of the

GLENN L. SORIANO
BARANGAY KAGAWAD
above-mentioned subject for any legal intent and for whatever purposes

it may serve him/her. CINDY S. ALCARAZ

BARANGAY KAGAWAD

PURPOSE:_________________ ______________________
JENNIFER P. DUQUE
BARANGAY KAGAWAD
SIGNATURE OVER PRINTED NAME

EVELYN C. BALILA
BARANGAY KAGAWAD
CTC NO.:______________
Issued on:______________
Issued at :BARANGAY URAYONG CABA LA UNION DANNY D. ESTIPULAR
SK CHAIRMAN

Amount Paid:
OR NO. : CLAIRE D. LINDE
Date Issued : BARANGAY SECRETARY
Issued at : BARANGAY URAYONG, CABA, LA UNION
NOTE:Valid for one year from the date of issuance. ANTONIO M. ADA JR.
“Not valid without Barangay Official dry seal” BARANGAY TREASURER

DST PAID SAMUEL R. CAMACHO

PUNONG BARANGAY