Republic of the Philippines

Sangguniang Barangay Province of Quezon

Municipality of San Francisco
HON. MARCOS P. GONZALES Barangay Sto. Niño
Barangay Captain
OFFICE OF THE PUNONG BARANGAY

HON. HERMINIGILDA B.
CERTIFICATE OF BARANGAY CLEARANCE
CABINTOY
Kagawad
To Whom it May Concern:

This is to certify that

HON. MIRAFLOR A. ATATADO
Kagawad Mr./Mrs. Ms. ________________________________________,
______ years old, single/married/widow, Filipino Citizen, is a
bonafide resident of Purok ___, Sitio____________________ of
HON. MACHO PANLUBASAN
Kagawad Barangay Sto. Niño, San Francisco, Quezon. He/She is known to
be person of good moral character and good standing in
HON. JAYSON E. ABAJA community. This certifies further that He/She has no derogatory
Kagawad record in the “Katarungang Pambarangay” as per record kept and
filed in this office: (Book III, Chapter 7, Sec. 399-422; R.A.
HON. ALLAN C. MAHINAY 7160).
Kagawad
SIGNED and ISSUED this _______ day of
HON. RODOLFO M. ERNA _______________, 2018 at Barangay Sto. Niño, San Francisco,
Kagawad Quezon, Philippines.

HON. SEPTICIO D. ROMASANTA

Kagawad
CONCORDIO A. ESBER
Barangay Secretary
HON. WARREN DAVE E. PAYAO
SK Chairman
MARCOS P. GONZALES
Barangay Captain
BENJAMIN L. CAPERIÑA
Brgy. Treasurer

CONCORDIO A. ESBER
Signature of Taxpayer:____________________________
Barangay Secretary
Community Tax Certificate No. _____________________
Issued on _________________________
Issued at _________________________
Amount Paid: ______________ Right Thumbmark