Barangay Officials: HON. Arturo G. Gaufo Barangay Captain Kgd. Ruel G. Trinidad Committee on Appropriation Kgd. Samson D.

Orge Comm. on Health Kgd. Rogelio F. Fulgar Comm. on Trade and Industry Kgd. Aida G. Gajo Comm. on Agriculture Kgd. Santiago N. Gallanosa Comm. on Education Kgd. Jonathan G. Galindes Comm. on Peace and Order Kgd. Evelyn E. Erlano Comm. on Infrastructure Jeoffrey G. Galindes SK Chairman Remedios F. Pulga Brgy. Treasurer Elmo G. Gabanzo Brgy. Secretary Mario Gayta Chief Tanod

Republic of the Philippines Province of Sorsogon Municipality of Sta. Magdalena Barangay San Isidro

OFFICE OF THE BARANGAY CAPTAIN

Control No.: ___________________ Date: _________________________

BARANGAY CLEARANCE
TO WHOM IT MAY CONCERN:

This is to certify that _______________________________________________, [Single/ Widow/ Married to: ________________________________________ ], [Age: _________ ], a Filipino resident of this barangay with postal address at

__________________________________________________ , has never been charged for any kind of offense and has no pending case, civil or criminal, upon the Lupong Tagapamayapa of this Barangay as of this date.
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Issued this _____

day of [Month] __________________, [Year] ___________ for

whatever legal purpose it may serve.

Hon. Arturo G. Gaufo Barangay Captain

_________________________________________ Applicant [Signature over printed name]

Community Tax No: _______________________ Paid under O.R. No: _______________________ Issued on: ________________________________ Issued at: ________________________________
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