REPUBLIC OF THE PHILIPPINES
PROVINCE OF QUEZON
MUNICIPALITY OF TAGKAWAYAN
BARANGAY COLONG COLONG
BARANGAY CLEARANCE
HON. ANTONIO E. SALAMAT
Punong Barangay
HON. ESTELA L. BAGAPORO
Committee on Solid Waste &
Management / Committee on Trade
& Industry
HON. JOSEPHINE R. MARAVILLA
Committee on Appropriation /
Committee on Women & Family /
Tourism
HON. ISAGANI H. ANIHAY
Committee on Education and Legal
Matter / BCPC
HON. DIOSDADO V. LUMAS
Committee on Infrastructure /
Committee on Human Rights
Action Officer
HON. ROMEO N. JAVIER
Committee on Agriculture /
Committee on BPOC
HON. VIRGINIA M. ALEGRE
Committee on Social Welfare
SK JESSABEL L. PANUELOS
Committee on Sports & Development
ROMANCITO R. BELANO
Barangay Treasurer
GENEROSO R. LUMAS
Barangay Secretary
TO WHOM IT MAY CONCERN:
This is to certify that as per second, the person whose name,
photo and signature appearing herein has requested a
CLEARANCE from this office with the following detail/s;
Last Name: ___________________________________________
First Name: ___________________________________________
Middle Name: _________________________________________
Birth Date: ____________________________________________
Marital Status: _________________________________________
Citizenship: ___________________________________________
Address: _____________________________________________
_____________________________________________________
PURPOSE: ___________________________________________
REMARKS: ___________________________________________
This certification is issued upon the request of the above subject for
the purpose stated.
________________________________
Signature Over Printed Name of Claimant
ESTELA L. BAGAPORO
Acting Barangay Captain
DATE ISSUED:____________________
(6) Six Months Validity
Validity of this CLEARANCE from the Date of Issuance:
Applicants Thumb Mark
PAID UNDER THE FOLLOWING:
Date Issued:______________________
OR Number:_____________________
Clearance Amt.:___________________
CTC Details:______________________
CTC Date Issued: _________________
CTC Amt. Paid: ___________________
CTC No. _________________________
CTC Place Issued: _________________
NOT VALID WTHOUT SEAL
PAID DOCUMENT