Republic of the Philippines

Cordillera Administrative Region

Province of Abra

MUNICIPALITY OF BUCLOC

CLEARANCE FOR CUTTING OF LOG FOR HOUSING

N0.: _____
DATE: ________________

Name of Applicant: ______________________________________._______________

(Surname) (1st Name) (MI) (Signature)
Operation: ______________________ _________ __________
(Complete name of owner) (Reg. N0.) (PTO N0.)
Form of Payment:
( ) Cash:____________ ( ) In kind: ___________________________________
Purpose/s:
( ) Interior Appliance/s ( ) Skeletal ( ) Whole House ( ) Repair

Location/site of Cutting: __________________________________________________

Classification: ( ) Soft wood ( ) Hard wood

Delivery Site: ___________________________________________________________

Number of Pieces: (Please attach separate list of complete items and measurement or
volume)

Attending Sheriff: _______________________ ______________________

(Name) (Signature)
Issuing Officer: ________________________ ______________________
(Name) (Signature)
Classification of log/s: ( ) Finish ( ) Semi-Finish

Approving Body:

BANNAS B. BAYONGAN JOHNY C. COLET

(SB Com. Member on Customary Law) (Lapat Representative)

MARCELO LIAGAO
(Barangay Representative)

Noted by:
GYBEL B. CARDENAS
(Municipal Mayor)