Republic of the Philippines
Province of Samar
LEMERY, BATANGAS
SAMBAL IBABA
Mobile No. 0919-1234567
LUZVIMINDA T. GOMEZ
PUNONG BARANGAY
ALFREDO A. BERNAL
BARANGAY KAGAWAD
ROWENA D. ALCARAZ
BARANGAY KAGAWAD
JASMIN T. ARANDIA
BARANGAY KAGAWAD
APRIL D. RAMOS
BARANGAY KAGAWAD
MADONNA D. ARANDIA
BARANGAY KAGAWAD
JANREY C. DELA LUNA
BARANGAY KAGAWAD
RODEL G. CORTEZ
BARANGAY KAGAWAD
OFFICE OF THE BARANGAY CAPTAIN
BARANGAY CLEARANCE
TO WHOM IT MAY CONCERN:
This is to certify that Juan dela Cruz, is a permanent resident of SAMBAL IBABA and that he/she is known to me to be of good moral character.
This certification/clearance is hereby issued to the above-named person for whatever legal purpose it may serve him/her best.
NOT VALID WITHOUT SEAL:
Tax Payer's Signature