KP Forms

KP Form No.
01
Republic of the Philippines
Province of Agusan del Norte
MUNICIPALITY OF BUENAVISTA
Barangay Poblacion 4
OFFICE OF THE PUNONG BARANGAY
_______________________
(Date)
NOTICE TO CONSTITUTE THE LUPON
TO ALL BARANGAY MEMBERS AND ALL OTHER PERSONS CONCERNED:
In compliance with Section 1(a), Chapter 7, Title One, Book III, Local Government Code of 1991
(Republic Act No. 7160), of the Katarungang Pambarangay law, notice is hereby given to constitute the
Lupong Tagapamayapa of this Barangay. The person I am considering for appointment:
1. Sulpecia M. Lumbay
She has been chosen on the basis of her suitability for the task of conciliation considering her
integrity, impartiality, independence of mind sense of fairness and reputation for probity in view of her
age, social standing in the community, tact, patience, resourcefulness, flexibility, open mindedness and
other relevant factors. The law provides that only those actually residing or working in the barangay who
are not expressly disqualified to be appointed as Lupon members.
All persons are hereby enjoined to immediately inform me of their opposition to or endorsement
of any or all of the proposed members or recommend to me other persons not included in the list but not
later than _August 24, 2010_. (last day of posting this notice).
FERDINAND G. DAGUIPA_
Punong Barangay
IMPORTANT : This notice is required to be posted in three (3) conspicuous places in the Barangay
For at least three (3) weeks.
WARNING : Tearing or defacing this notice shall be subject to punishment according to law.
KP Form No. 01
December 2, 2013
NOTICE TO CONSTITUTE THE LUPON
TO ALL BARANGAY MEMBERS AND ALL OTHER PERSONS CONCERNED:
In compliance with Section 1(a), Chapter 7, Title One, Book III, Local Government Code of 1991
(Republic Act No. 7160), of the Katarungang Pambarangay law, notice is hereby given to constitute the
Lupong Tagapamayapa of this Barangay. The persons I am considering for appointment are the following:
1. Mauricio P. Abrao
2. Rosita B. Badiang
3. Juanito T. Banzon
4. Vidal M. Cabasa
5. Greselda M. Carillo
6. Henry S. Dela Cerna
7. Manuel B. Edulzura
8. Teogenes P. Jamero, Sr
9. Jovenal M. Iting, Jr
10. Felix M. Lagare
12. Joel L. Maturan
13. Enrique M. Mulawan
14. Gemma H. Reston
They have been chosen on the basis of his suitability for the task of conciliation considering his
integrity, impartiality, independence of mind sense of fairness and reputation for probity in view of his
age, social standing in the community, tact, patience, resourcefulness, flexibility, open mindedness and
other relevant factors. The law provides that only those actually residing or working in the barangay who
are not expressly disqualified to be appointed as Lupon members.
All persons are hereby enjoined to immediately inform me of their opposition to or endorsement
of any or all of the proposed members or recommend to me other persons not included in the list but not
later than December 22, 2013. (last day of posting this notice).
MA. MINDA D. BARRIENTOS

Punong Barangay
IMPORTANT : This notice is required to be posted in three (3) conspicuous places in the Barangay
For at least three (3) weeks.
WARNING : Tearing or defacing this notice shall be subject to punishment according to law.
KP Form No. 02
January 6, 2013
APPOINTMENT
TO : _HENRY S. DELA CERNA
Pursuant to Chapter 7, Title One, Book III, Local Government Code of 1991 (Republic Act No.
7160), you are hereby appointed MEMBER of the LUPONG TAGAPAMAYAPA of this Barangay
effective upon taking your oath of office and until a new Lupon is constituted on the third year following
your appointment.

Punong Barangay
Attested:
_MARYLENE S. AGUILAR
Barangay Secretary
KP Form No. 02
January 25, 2013

(Date)
APPOINTMENT
TO : _SULPECIA M. LUMBAY
your appointment.
_FERDINAND G. DAGUIPA
Punong Barangay
Attested:
Barangay Secretary
KP Form No. 02
___December 1, 2007
(Date)
APPOINTMENT
TO : _
your appointment.

Punong Barangay
Attested:
Barangay Secretary
KP Form No. 03
December 27, 2013
NOTICE OF APPOINTMENT
HENRY S. DELA CERNA

Barangay 4_____________
Buenavista, Agusan del Norte
Sir :
Please be informed that you have been appointed by the Punong Barangay as MEMBER OF THE
LUPONG TAGAPAMAYAPA, effective upon taking your oath office and until a new Lupon is
constituted on the third year following your appointment. You may take your oath of office before the
Punong Barangay on the 6th day of January, 2014.
Very truly yours,
Barangay Secretary
KP Form No. 03
__December 27, 2014

(Date)
NOTICE OF APPOINTMENT
GRESELDA M. CARILLO
Barangay 4_____________
Sir :
Please be informed that you have been appointed by the Punong Barangay as MEMBER OF THE
LUPONG TAGAPAMAYAPA, effective upon taking your oath office and until a new Lupon is
constituted on the third year following your appointment. You may take your oath of office before the
Punong Barangay on the 6th day of January, 2014.
Very truly yours,
Barangay Secretary
KP Form No. 04
_September 1, 2010
LIST OF APPOINTED LUPON MEMBERS

As of September 2010
Listed hereunder are the duly appointed members of the Lupong Tagapamayapa in this Barangay
who shall serve as such upon taking their oath of office and until a new Lupon is constituted on the third
year following their appointment.
2. Emmanuel M. Domosmog
4. Josephine B. Jamero
5. Teogenes P. Jamero, Sr.
7. Robin S. Lumile
8. Arturo Q. Maturan
10. Fernando B. Sitoy
FERDINAND G. DAGUIPA
Punong Barangay
Attested:
MARYLENE S. AGUILAR_
Barangay/Lupon Secretary
Important:
This list shall be posted in three (3) conspicuous places in the Barangay of the duration of the
terms of office those named aboved.
Warning:
Tearing or defacing this notice shall be subject to punishment according to law.

KP Form No. 04
January 6, 2014
LIST OF APPOINTED LUPON MEMBERS

As of January 2014
Listed hereunder are the duly appointed members of the Lupong Tagapamayapa in this Barangay
who shall serve as such upon taking their oath of office and until a new Lupon is constituted on the third
year following their appointment.
2. Vidal M. Cabasa
3. Greselda M. Carillo
4. Henry S. Dela Cerna
6. Teogenes P. Jamero, Sr
7. Jovenal M. Iting, Jr
9. Joel L. Maturan

Punong Barangay
Attested:
MARYLENE S. AGUILAR_
Barangay/Lupon Secretary
Important:
This list shall be posted in three (3) conspicuous places in the Barangay of the duration of the
terms of office those named aboved.
Warning:
Tearing or defacing this notice shall be subject to punishment according to law.

KP Form No. 05
OATH OF OFFICE
7160), I _SULPECIA M. LUMBAY_____, being appointed MEMBER OF THE LUPONG
TAGAPAMAYAPA of this Barangay, do hereby solemnly swear (or affirm) that I will faithfully and
conscientiously discharge to the best of my ability my duties and functions as such member and as
member of the PANGKAT NG TAGAPAGKASUNDO in which I may be chosen to serve; that I will
support and defend its Constitution and obey the laws, legal orders and decrees promulgated by its duly
constituted authorities; and that I voluntarily impose upon myself this obligation without any mental
reservation or purpose of evasion.
____________________________
Member
SUBSCRIBED AND SWORN TO (or affirmed) before me this 1st day of February, 2013.
__FERDINAND G. DAGUIPA
Punong Barangay
KP Form No. 05
OATH OF OFFICE
7160), I _HENRY S. DELA CERNA_____, being appointed MEMBER OF THE LUPONG
____________________________
Member
SUBSCRIBED AND SWORN TO (or affirmed) before me this 6th day of January, 2014.

Punong Barangay
KP Form No. 05
OATH OF OFFICE
7160), I _SULPECIA M. LUMBAY_____, being appointed MEMBER OF THE LUPONG
____________________________
Member
SUBSCRIBED AND SWORN TO (or affirmed) before me this 2nd day of September , 2010.
Punong Barangay
KP Form No. 05
OATH OF OFFICE
7160), I _ARTURO Q. MATURAN_____, being appointed MEMBER OF THE LUPONG
____________________________
Member
SUBSCRIBED AND SWORN TO (or affirmed) before me this _1ST day of _December , 2007.
Punong Barangay
KP Form No. 06
OFFICE OF THE LUPONG TAGAPAMAYAPA
_____________________________
(Date)
WITHDRAWAL OF APPOINTMENT
TO: ________________________
After due hearing and with the concurrence of a majority of all the Lupong Tagapamayapa
members of this Barangay, your appointment as member thereof is hereby withdrawn effective upon
receipt hereof, on the following ground/s:
= Incapacity to discharge the duties of your office as shown by __________________________

___________________________________________________________________________
= Unsuitability by reason of _____________________________________________________

__________________________________________________________________________
(check whichever is applicable and detail or specify that act/s omission/s constituting the
ground/s for withdrawal):
_____________________________
Punong Barangay/Lupon Chairman
CONFORME (Signatures):
1. ___________________________________ 6. ___________________________________
2. ___________________________________ 7. ___________________________________
3. ___________________________________ 8. ___________________________________
4. ___________________________________ 9. ___________________________________
5. ___________________________________ 10. ___________________________________
Received this ______ day of ___________________, 2006.
_____________________________
Signature
Note: The members of the lupon conforming to the withdrawal must personally affix their signatures or
thumbmarks on the pertinent spaces above. The withdrawal must be conformed to by more than
one-half of the total number of members of the lupon including the Punong Barangay and the
member concerned.
KP Form No. 07
______________________ _________ _____ Barangay Case No.: _________________

_________________________________________ For : _____________________________
Complainant/s
-against-
_________________________________________
_________________________________________
Respondent/s
C O M PLAI N T
I/We, hereby complain against above-mentioned respondent/s for violation of my/our rights and
interest in the following manner:
____________________________________________________________________________________
THEREFORE, I/We pray that the following relief/s be granted to me/us in accordance with law
and/or equity.
_____________________________________
Made this ____th day of _______ , year ______.
_________________________________
Complainant/s
Received and filed this _____th day of ________ , _______.
_____________________________ ____
KP Form No. 07
TEODOLO G. BINOLIRAO__ _________ __ Barangay Case No.: ___11-2010_______

_________________________________________ For : Combatants in duel_____________
Complainant/s
-against-
ARNOL B. CAÑAREJO_____________________
_________________________________________
Respondent/s
C O M PLAI N T
Pagsugot nga hakuton ang mga butang sa balay sugo sa akong asawa.
and/or equity.
Dili na utruhon ang kasamok.
Made this 2nd day of June , year 2010.
_________________________________
Complainant/s
Received and filed this 2nd day of June , 2010.
___FERDINAND G. DAGUIPA____
KP Form No. 07
JULIETA O. BINOLIRAO___ _________ __ Barangay Case No.: ___12-2010_______

_________________________________________ For : Family dispute________________
Complainant/s
-against-
TEODOLO G. BINOLIRAO _____________________

_________________________________________
Respondent/s
C O M PLAI N T
Sa dili paghatag ug tarong sustento sa among anak nga nia kanako
and/or equity.
Sustentuan ang mga bata.
Made this 2nd day of June , year 2010.
_________________________________
Complainant/s
KP Form No. 07
ROBERTO D. LUMBAY, SR.___ _________ Barangay Case No.: ___13-2010_______

_________________________________________ For : Harassment ________________
Complainant/s
-against-
TEODOLO G. BINOLIRAO _____________________

_________________________________________
Respondent/s
C O M PLAI N T
Panghasi didto sa among internetan sa Matabao adtong byernes sa alas 7:45 sa gabii kapin kun kulang ug
pagsulti nga buk-an ko ug ulo ug pagsulti nga kabit ko ni Julieta.
and/or equity.
Pabayron sa pagpakaulaw .
Made this 21st day of June , year 2010.
_________________________________
Complainant/s
KP Form No. 07
JULITA S. SEMBLANTE______ _________ Barangay Case No.: ___14-2010________

_________________________________________ For : Intriguing against honor__________
Complainant/s
-against-
BENIGNA P. TABANAO ____________________

__________________________________________
Respondent/s
C O M PLAI N T
Pag-istorya-istorya sa mga tawo nga ako ga tago-tago kay daghan utang ug pagpadungog-dungog ngadto
sa akong anak nga dili magpakabo ug tubig sa bomba nahimutang sa ilang natad.
and/or equity.
Dili na magpataka ug istorya nga makaulaw ug dili magdili kanamo nga mukabo ug tubig sa bomba nga
anaa sa ilang natad .
Made this 27th day of July , year 2010.
_________________________________
Complainant/s
Received and filed this 27th day of July , 2010.
KP Form No. 08
NOTICE OF HEARING
(MEDIATION PROCEEDINGS)
TO : _ _______________________ ___________-
__________ _____________
____________________________
Complainant/s
You are hereby required to appear before me on the _____ day of ______ , ______ at _____
o`clock in the morning/afternoon for the hearing of your complaint.
This ______ day of _____ _______.
__________________________
Complainant/s
_____________________________
_____________________________
KP Form No. 08
NOTICE OF HEARING
TO : _ JULITA S. SEMBLANTE 14-2010

Barangay 4 _____________
Complainant/s
You are hereby required to appear before me on the 28 th day of July , 2010 at 2:00 o`clock in the
morning/afternoon for the hearing of your complaint.
This 27th day of July 2010.
Complainant/s
_____________________________
_____________________________
KP Form No. 08
NOTICE OF HEARING
TO : _ CARMELA T. GULAY 10-2010

Barangay 4 _____________
Complainant/s
You are hereby required to appear before me on the 5 th day of May , 2010 at 9:00 o`clock in the
morning/afternoon for the hearing of your complaint.
This 30th day of April 2010.
Complainant/s
_____________________________
_____________________________
KP Form No. 09
______________________. __________________ Barangay Case No.: _______________

__________________________________________ For : ____________________________
Complainant/s
-against-
___________________ _____________________
_________________________________________
Respondent/s
S U M M O N S
TO : ____________________ ____________________
______________________________________
Respondents
You are hereby summoned to appear before me in person, together with your witnesses, on the _____ day
of ______ _, ______ at ______ o`clock in the morning/afternoon, then and there to answer to a complaint made
before me, copy of which is attached hereto, for mediation/conciliation of your dispute with complainant/s.
You are hereby warned that if you refused or willfully fail to appear in obedience to this summons, you
may be barred from filing any counterclaim arising from said complaint.
FAIL NOT or else face punishment as for contempt of court.
This _____ day of _____ _, ______

___________________________ ___
Punong Barangay/Pangkat Chairman
OFFICER`S RETURN
I served this summons upon respondent ___________________ on the ______ day of _________
______________, 2010, and upon respondent ___________________________ to the ________ day of
________________________, 2010, by:
(Write names of Respondent/s before mode by which he/they was/were served.)
Respondent/s
_______________________ 1. handling to him/them said summons in person, or
_______________________ 2. handling to him/them said summons and he/they refused to receive it, or
_______________________ 3. leaving said summons at his/their dwelling with _________________________
(name)
a person of suitable age and discretion residing therein, or
_______________________ 4. leaving said summons at his/their office/place of business with ________
______________________, a competent person in charge thereof.
(name)
________________________________
Officer
Received by the respondent/s and or representative/s:
________________________________ ______________________________
(Signature) (Signature)
KP Form No. 09
JULITA S. SEMBLANTE __________________ Barangay Case No.: ___14-2010_______

__________________________________________ For : Intriguing against honor_________
Complainant/s
-against-
BENIGNA P. TABANAO ____________________
__________________________________________
Respondent/s
S U M M O N S
TO : BENIGNA P. TABANAO ____________________
______________________________________
Respondents
You are hereby summoned to appear before me in person, together with your witnesses, on the 28th day of
_July _, 2010 at 2:00 o`clock in the morning/afternoon, then and there to answer to a complaint made before me,
copy of which is attached hereto, for mediation/conciliation of your dispute with complainant/s.
This 27th day of July _, 2010.

__FERDINAND G. DAGUIPA ___
OFFICER`S RETURN
________________________, 2010, by:
Respondent/s
(name)
(name)
________________________________
Officer
________________________________ ______________________________
KP Form No. 09
CARMELA T. GULAY ________________ Barangay Case No.: ___10-2010_______

__________________________________________ For : Corrupting minor______________
Complainant/s
-against-
JASPEL A. BALASABAS ___________________
_________________________________________
Respondent/s
S U M M O N S
TO : JASPEL A. BALASABAS _______________________
______________________________________
Respondents
_May _, 2010 at 9:00 o`clock in the morning/afternoon, then and there to answer to a complaint made before me,
This 30th day of April _, 2010.

__FERDINAND G. DAGUIPA ___
OFFICER`S RETURN
________________________, 2010, by:
Respondent/s
(name)
(name)
________________________________
Officer
________________________________ ______________________________
KP Form No. 09
SERCONSECION BASUBAS, et. al. __________ Barangay Case No.: __05-2010_____

_______________________________ __________ For Land disputes________________
Complainant/s
-against-
_ ORONCIA KUIZON, FELIPE BALANSAG, et. al.
_ ___________________ _______________________
Respondent/s
S U M M O N S
TO : ORONCIA KUIZON, FELIPE BALANSAG, et. al. ________________________________

___________________________________ _______________________________
Respondents
_April _, 2010 at 9:00 o`clock in the morning/afternoon, then and there to answer to a complaint made before me,
This 28th day of January _, 2010.

__AGRIPINO P. POJAS__ ___
/Pangkat Chairman
OFFICER`S RETURN
________________________, 2010, by:
Respondent/s
(name)
(name)
_______________________________
Officer
________________________________ ______________________________
KP Form No. 10
NOTICE FOR CONSTITUTION OF PANGKAT
TO:___SUSAN P. MANTILLA_______ RICO B. KUIZON___________

_____________________________ _______________________________
_____________________________ _______________________________
Complainant/s Respondent/s
You are hereby required to appear before me on the 5th day of March , 2010 at 10:00 o`clock in
the morning/afternoon for the constitution of Pangkat ng Tagapagkasundo which shall conciliate your
dispute. Should you fail to agree on the Pangkat membership or to appear on the aforesaid date for the
constitution of the Pangkat, I shall determine the membership thereof by drawing lots.
This 4th day of March, 2010.
___ FERDINAND G. DAGUIPA_

Punong Barangay
Notified this ____ day of ____________, 2010.
________________________________________ ____________________________________
KP Form No. 11
_SERCONSECION BASUBAS, et. al._______ Barangay Case No. : ___05-2010______

______________________________________ For : ___Land Disputes______________
Complainant/s
-against-
_FELIPE BALANSAG, et. al. ______________

Respondent/s
NOTICE TO CHOSEN PANGKAT MEMBER
__April 27, 2010______________
TO: ___JUANITO T. BANZON
Notice is hereby given that you have been chosen member of the Pangkat ng Tagapagkasundo to
amicably conciliate the dispute between the parties in the above-entitled case.
____FERDINAND G. DAGUIPA__
Punong Barangay
Received this ______ day of _________________, 2010.
________________________________
Pangkat Member
KP Form No. 12
_SERCONSECION BASUBAS, et. al. _______ ORONCIA KUIZON, FELIPE ___

_____________________ _________________ BALANSAG, et. al.___________
__________________________
NOTICE OF HEARING
(CONCILIATION PROCEEDING)
You are hereby required to appear before the Pangkat on the _29th day of April,
2010, at __9:00__ o`clock in the morning/afternoon for a hearing of the above-entitled case.
This ____28th day of April, 2010.
_________________________
Pangkat Chairman
Notified this ______ day of ________________, 2010.
____________________________________ __________________________________
____________________________________ __________________________________
KP Form No. 13
___________________________________ Barangay Case No.: ______________

___________________________________ For : __________________________
Complainant/s
-against-
_________________ _________________
__________________________________
Respondent/s
S U B P O E N A
TO: ________________________________ __________________________________

________________________________ __________________________________
Witnesses
You are hereby commanded to appear before me on the __8th _ day of __April , 2010 at ___9:00
o`clock in the morning, then and there to testify in the hearing of the above-captioned case.
This ______ day of ______ , ________.
________________________________
(Cross out whichever one is not
applicable)
KP Form No. 14
_______________________________________ Barangay Case No.: ________________

_______________________________________ For : ___________________________
Complainant/s
-against-
_______________________________________
_______________________________________
Respondent/s
AGREEMENT FOR ARBITRATION
We hereby agree to submit our dispute for arbitration to the Punong Barangay/Pangkat ng
Tagapagkasundo (Please cross out whichever is not applicable) and bind ourselves to comply with the
award that may be rendered thereon. We have made this agreement freely with a full understanding of its
nature and consequence.
Entered into this _____ day of ________________, 2006.
_____________________________________ __________________________________
_____________________________________ __________________________________
Attestation:
I hereby certify that the foregoing agreement for Arbitration was entered into by the parties freely
and voluntarily, after I had explained to them the nature and consequences of such agreement.
_____________________________________
(Cross out whichever one is not applicable)
KP Form No. 15
______________________________________ Barangay Case No. _____________________

______________________________________ For : ________________________________
Complainant/s
-against-
______________________________________
______________________________________
Respondent/s
ARBITRATION AWARD
After hearing the testimonies given and careful examination of the evidence presented in this
case, award is hereby made as follows:
Made this _____ day of ________________, 2006 at ______________________.
____________________________________
____________________________________
Member
_____________________________________
Member
Attested:
_________________________________________
Punong Barangay/Lupon Secretary
 To be signed by either, whoever made the arbitration award.

 To be signed by the Punong Barangay if the award is made by the Pangkat Chairman, and by
the Lupon secretary if the award is made by the Punong Barangay.
KP Form No. 16
___ROBERTO LUMBAY, SR. .__________ Barangay Case No.: _06-2010___

___ __________________________ ________ For : Collection of debt___________
Complainant/s
-against-
___JULIANA TAPALES_______________ _ __
_______________________________ ______ _
Respondent/s
AMICABLE SETTLEMENT
We, complainant/s and respondent/s in the above captioned case, do hereby agree our dispute as
follows:
ANG PINIRMAHAN NGA PHP 2,000.00 BAYRAN NIINING ADLAWA.
and bind ourselves to comply honestly and faithfully with the above terms of settlement.
Entered into this _13th day of _April __, 2010.
______________________________________ _________________________________
______________________________________ _________________________________
ATTESTATION
I HEREBY CERTIFY THAT THE FOREGOING AMICABLE SETTLEMENT WAS
ENTERED INTO BY THE PARTIES FREELY AND VOLUNTARILY, AFTER I HAD EXPLAINED TO
THEM THE NATURE AND CONSEQUENCE OF SUCH SETTLEMENT.
_FERDINAND G. DAGUIPA___________
Punong Barangay
KP Form No. 16
___GUARITA ADELANTAR___________ Barangay Case No.: _25-2009___

___ __________________________ ________ For : _______________________
Complainant/s
-against-
___JERRIE G. PALOGA_______________ _ __
_______________________________ ______ _
Respondent/s
AMICABLE SETTLEMENT
follows:
KAMI NAGKASABOT NGA TUNGA-ON NALANG ANG DAMAGE NGA PHP 2,500.00 SA TAG
PHP 1,250.00 UG KARONG ADLAWA MUHATAG SI JERRIE UG PHP 1,000.00 UG ADUNAY
BALANCE NGA PHP 250.00 BAYARAN SUNOD BULAN.
Entered into this _12th day of _November __, 2009.
______________________________________ _________________________________
______________________________________ _________________________________
ATTESTATION

Punong Barangay
KP Form No. 16
___JEAN P. OCLARIT___________ Barangay Case No.: _04-2010_________

___ ANECITA T. PUTANE_________ For : Harassment and Grave Threat_____
Complainant/s
-against-
___ARNULFO Q. TIEMPO___________________ _ __
_______________________________ ______ _
Respondent/s
AMICABLE SETTLEMENT
follows:
MANGAYO UG PASAYLO, DILI NA UTRUHON ANG PAGBUHAT NGA PAGPANGHURAW,
PAGGAMIT UG HINAGIBAN UG PALIATN BAG-O ANG TERMOS NGA NABUAK KARONG
February 12, 2010.. .
Entered into this _8th day of _February __, 2010.
______________________________________ _________________________________
______________________________________ _________________________________
ATTESTATION

Punong Barangay
KP Form No. 16
___SUSAN P. MANTILLA__________ Barangay Case No.: _03-2010_________

________________________________ For : Oral Defamation______________
Complainant/s
-against-
___RICO B. KUIZON___________________ _ _
_______________________________ ______ _
Respondent/s
AMICABLE SETTLEMENT
follows:
AFFIX SIGNATURE FOR RECONCILIATION.
Entered into this _27th day of _March __, 2010.
______________________________________ _________________________________
______________________________________ _________________________________
ATTESTATION

Punong Barangay
KP Form No. 16
_DRA. LILIAN L. AMOROSO______ Barangay Case No.: _09-2010_________

________________________________ For : Ejectment____________________
Complainant/s
-against-
_ALEX D. DUMANGLAS ________________

_______________________________ ______ _
Respondent/s
AMICABLE SETTLEMENT
follows:
OCCUPANCY OF MR. DUMANGLAS EXTEND FROM THIS DATE APRIL 30, 2010 TO APRIL 30,
2011 EXACTLY ONE (1) YEAR AND WITHIN ONE YEAR OF STAY DRA. AMOROSO WILL
START THE IMPROVEMENTS OF HER OWN LAND AND IN THE EXPIRATION OF DATE MR.
DUMANGLAS FULLY VACATED THE LAND WITH ALL THE PROPERTIES AND TERMINATE
HIS RIGHTS TO OCCUPY THE LAND
Entered into this _30th day of _April __, 2010.
______________________________________ _________________________________
______________________________________ _________________________________
ATTESTATION

Punong Barangay
KP KP Form No. 16
___ARLENE DANUCO____________ Barangay Case No.: _08-2010_________

________________________________ For : Oral Defamation and Threat_________
Complainant/s
-against-
___MAXIMINO DANUCO________________
_______________________________ ______ _
Respondent/s
AMICABLE SETTLEMENT
follows:
BAHIN SA PAGSULTI NGA NANGAWAT UG BUGAS BAKWION UG MANGAYO UG PASAYLO

UG BAHIN SA PAGBAHAD DILI NA UTRUHON UG MANGAYO UG PASAYLO.
Entered into this _22nd day of _April __, 2010.
______________________________________ _________________________________
______________________________________ _________________________________
ATTESTATION

Punong Barangay
KP Form No. 16
___CARMELA T GULAY__________ Barangay Case No.: _10-2010_________

________________________________ For : Corrupting minor_____________
Complainant/s
-against-
___JASPEL A. BALASABAS________________
_______________________________ ______ _
Respondent/s
AMICABLE SETTLEMENT
follows:
DILI NA MAGSAMOK-SAMOK MINTRAS DILI PA HINGKOD ANG PANUIGON UG WALA PAY

TRABAHO UG BAHIN SA PAGSUPURTA SA BATA WALAY TAGAD MAKATRABAHO MAN O
WALA, MAGAHATAG KAUSA MATAG BULAN.
Entered into this _5TH day of _May __, 2010.
______________________________________ _________________________________
______________________________________ _________________________________
ATTESTATION

Punong Barangay
KP Form No. 16
___TEODOLO G. BINOLIRAO______ Barangay Case No.: _11-2010_________

________________________________ For : Combatants in duel_____________
Complainant/s
-against-
___ARNOL B. CAÑAREJO_________
________________________________
Respondent/s
AMICABLE SETTLEMENT
follows:
WAD-ON ANG KASUKO TALI NAMONG DUHA.
Entered into this _2nd day of _June __, 2010.
______________________________________ _________________________________
______________________________________ _________________________________
ATTESTATION

Punong Barangay
KP Form No. 16
___ROBERTO D. LUMBAY, SR.____ Barangay Case No.: _13-2010_________

________________________________ For : Harassment__________________
Complainant/s
-against-
___TEODOLO G. BINOLIRAO______
________________________________
Respondent/s
AMICABLE SETTLEMENT
follows:
Bayran ug Php 10,000.00 ang pagpakaulaw nako kang Nong Bert karong katapusan sa July 2010 ug dili
na magsamok-samok, manghasi ni ining ug sa internetan.
Entered into this _24th day of _June __, 2010.
______________________________________ _________________________________
______________________________________ _________________________________
ATTESTATION

Punong Barangay
KP Form No. 16
___JULIETA O. BINOLIRAO_______ Barangay Case No.: _12-2010_________

________________________________ For : Family dispute________________
Complainant/s
-against-
___TEODOLO G. BINOLIRAO_____
________________________________
Respondent/s
AMICABLE SETTLEMENT
follows:
MAGHATAG SUSTENTO SA MGA BATA KADA GABAS.
Entered into this _2nd day of _June __, 2010.
______________________________________ _________________________________
______________________________________ _________________________________
ATTESTATION

Punong Barangay
Form No. 17
__MODESTO D. BOHOL, ET. AL._________ Barangay Case No.: _____27-2007_______

________________________________________ For : _____HARASSMENT____________
Complainant/s
-against-
__SALVACION M. FIEDACAN____________
________________________________________
Respondent/s
R E P U D I A T I O N
I/We hereby repudiate the settlement/agreement for arbitration on the ground that my/our consent
was vitiated by:
(Check out whichever is applicable)
- Fraud (State details) request of the head complainant Fr. Nedie Dejado for further
Settlement of the case between him and Mrs. Salvacion Fiedacan_______________
____________________________________________________________________
- Violence. (State details) ________________________________________________
____________________________________________________________________
____________________________________________________________________
- Intimidation. (State details) _____________________________________________

____________________________________________________________________
____________________________________________________________________
This _30th day of ___August , 2007.
_______________________________________ __________________________________
________________________________________ __________________________________

Acting Punong Barangay/Pangkat Chairman/Member
Received and filed this _30th day of __August , 2007.
______MA. MINDA D. BARRIENTOS ____

Punong Barangay
*Failure to repudiate the settlement or the arbitration agreement within the time limits respectively set
(ten days from date of settlement and five days from date of arbitration agreement) shall be deemed a
waiver of the right to challenge on solid grounds.
KP Form No. 18
_____________________________________ Barangay case No.: ______________________

______________________________________ For :_________________________________
Complainant/s
-against-
______________________________________
______________________________________
Respondent/s
NOTICE OF HEARING
(RE:FAILURE TO APPEAR)
TO: _______________________________
_______________________________
Complainant/s
You are hereby required to appear before me/the Pangkat on the ______ day of _____________,
2006, at _______ o`clock in the morning/afternoon to explain why you failed to appear for
mediation/conciliation scheduled on _________________, 2006 and why your complaint should not be
dismissed, a certificate to bar the filing of your action in court/government office should not be issued,
and contempt proceedings should not be initiated in court for willful failure or refusal to appear before
the Punong Barangay/Pangkat ng Tagapagkasundo.
This _______ day of ____________________-, 2006.
_________________________________
(Cross out whichever is not applicable)
Notified this ______ day of ___________________, 2006.
Complainant/s
___________________________________
__________________________________
Respondent/s
___________________________________
___________________________________
KP Form No. 19
____RYAN JAY R. MEDINA___________ Barangay Case No.: __29-2007________

____________________________________ For : _____________________________
Complainant/s
-against-
__GIANCARLO RODOLFO L. PABILLORE

____________________________________
Respondent/s
NOTICE OF HEARING
(RE : FAILURE TO APPEAR)
TO :GIANCARLO RODOLFO L. PABILLORE

___________________________________
Respondent/s
You are hereby required to appear before me/the Pangkat on the __10th day of __September ,
2007 at _10:00 o`clock in the morning/afternoon to explain why you failed to appear for
mediation/conciliation scheduled on _September 7, 2007, and why your counterclaim (if any) arising
from the complaint should not be dismissed, a certificate to bar the filing of said counterclaim in
court/government office should not be issued, and contempt proceedings should not be initiated in court
for willful failure or refusal to appear before the Punong Barangay/Pangkat ng Tagapagkasundo.
This _7th day of __September , 2007.
____MA. MINDA D. BARRIENTOS_

Acting Punong Barangay/Pangkat
Chairman
(Cross out whichever is not applicable)
Notified this ______ day of __________________, 2007.
Respondent/s
________________________________
________________________________
Complainant/s
________________________________
________________________________
KP Form No. 20
OFFICE OF THE LUPONG TAGAPAMYAPA
____________________________________ Barangay case No. : _________________

____________________________________ For : _____________________________
Complainant/s
-against-
____________________________________
____________________________________
Respondent/s
CERTIFICATION TO FILE ACTION
This is to certify that:
1. There has been a personal confrontation between the parties before the Punong
Barangay/Pangkat ng Tagapagkasundo
2. A settlement was reached:
3. The settlement has been repudiated in a statement sworn to before the Punong Barangay by
______________________ on ground of _______________________________________________.
4. Therefore, the corresponding complaint for the dispute may now be filed in court/government
office.
This ________ day of _________________, 2006.
__________________________________
Lupon Secretary
Attested:
______________________________
Lupon Chairman
KP Form No. 20-A

__ELMA YBAÑEZ__________________ Barangay Case No.: ____01-2010______

___________________________________ For : ____Collection of debt___________
Complainant/s _____________________________
-against-
PURITA TABANAO_______________
____________________________________
Respondent/s
1. There has been a personal confrontation between the parties before the Punong Barangay but
mediation failed.
2. The Pangkat ng Tagapagkasundo was constituted but the personal confrontation before the
Pangkat likewise did not result into a settlement.
3. Therefore, the corresponding complaint for the dispute may now be filed to court/government
office.
This _17th_ day of _March_ , 2009.
____MANUEL EDULZURA_ ____

Pangkat Secretary
Attested by:
ARTURO Q. MATURAN___
Pangkat Chairman
KP Form No. 20-A

SERCONSECION B. BASUBAS, et. al. _ Barangay Case No.: ____05-2010______

___________________________________ For : ____Land Disputes_____________
Complainant/s _____________________________
-against-
ORONCIA B. KUIZON, FELIPE BALANSAG, et. al.

____________________________________
Respondent/s
1. There has been a personal confrontation between the parties before the Punong Barangay but
mediation failed.
2. The Pangkat ng Tagapagkasundo was constituted but the personal confrontation before the
Pangkat likewise did not result into a settlement.
3. Therefore, the corresponding complaint for the dispute may now be filed to court/government
office.
This _31st_ day of _April_ , 2010.
____MANUEL EDULZURA_ ____

Pangkat Secretary
Attested by:
AGRIPINO P. POJAS___
Pangkat Chairman
KP Form No. 20-B

___________________________________ Barangay Case No.: ______________________

___________________________________ For : __________________________________
Complainant/s
-against-
___________________________________
___________________________________
Respondent/s
1. There was a personal confrontation between the parties before the Punong Barangay but
mediation failed;
2. The Punong Barangay set the meeting of the parties for the constitution of the Pangkat;
3. The respondent willfully failed or refused to appear without justifiable reason at the
conciliation proceedings before the Pangkat;
4. Therefore, the corresponding complaint for the dispute may now be filed in court/government
office.
_____________________________________
Pangkat Secretary
Attested:
______________________________
Pangakat Chairman
KP Form No. 21
_______________________________________ Barangay Case No.: ____________________

_______________________________________ For: ________________________________
Complaint/s
-against-
_______________________________________
_______________________________________
Respondent/s
CERTIFICATION TO BAR ACTION
This is to certify that the above-captioned case was dismissed pursuant to the order dated
____________________, for complainant/s _______________________ (name) willful failure or refusal
to appear for hearing before the Punong Barangay/Pangkat ng Tagapagkasundo and therefore
complainant/s is/are barred from filing an action in court/government office.
This ______ day of ___________________, 2006.
____________________________________
Lupon Secretary/Pangkat Secretary
Attested:
_______________________________
Lupon Chairman/Pangkat Chairman
Important : If Lupon Secretary makes the certification, the Lupon Chairman attests. If the Pangkat
Secretary makes the certification, the Pangkat Chairman attests.
KP Form No. 22
________________________________ Barangay Case No.: ___________________

________________________________ For : _______________________________
Complainant/s
-against-
________________________________
________________________________
Respondent/s
CERTIFICATION TO BAR COUNTERCLAIM
This is to certify that after prior notice and hearing, the respondent/s _________________(name)
have been found to have willfully failed or refused to appear without justifiable reason before the Punong
Barangay/Pangkat ng Tagapagkasundo and therefore respondent/s is/are barred from the filing his/their
counterclaim (if any) arising from the complaint in court/government office.
This ______ day of ________________, 2009.
__________________________________
Lupon Secretary/Pangkat Secretary
Attested:
__________________________________
Lupon Chairman/Pangkat Chairman
Important : If the Lupon Secretary makes the certification the, Lupon Chairman attests, If the Pangkat
secretary makes the certification, the Pangkat Chairman attests
KP Form No. 23
GUILLERMA M. CASQUEJO________ Barangay Case No.: _31-2007___

Complainant/s For : Collection of debt_______
-against-
MARIETTA E. ASIS________________
Respondent
MOTION FOR EXECUTION
Complainant/s Respondent/s state as follows:
1. On _August 31, 2007 the parties in this case signed an amicable settlement/received the
(date)
arbitration award rendered by the Lupon Chairman/Pangkat ng Tagapagkasundo;
2. The period of ten (10) days from the above-stated date has expired without any of the parties
filing a sworn statement of repudiation of the settlement before the Lupon Chairman/ a petition for
nullification of the arbitration award in court;
The amicable settlement/arbitration award is now final and executory.
WHEREFORE, Complainant/s Respondent/s requests that the corresponding writ of execution

be issued by the Lupon Chairman in this case.
________________________-
(Date)
___________________________
KP Form No. 23
JACKUELINE A. UNABIA________ Barangay Case No.: _10-2013___

-against-
MERCY G. BONJOC________________
Respondent
MOTION FOR EXECUTION
Complainant/s Respondent/s state as follows:
1. On _August 14, 2013 the parties in this case signed an amicable settlement/received the
(date)
arbitration award rendered by the Lupon Chairman/Pangkat ng Tagapagkasundo;
2. The period of ten (10) days from the above-stated date has expired without any of the parties
filing a sworn statement of repudiation of the settlement before the Lupon Chairman/ a petition for
nullification of the arbitration award in court;
The amicable settlement/arbitration award is now final and executory.
WHEREFORE, Complainant/s Respondent/s requests that the corresponding writ of execution

be issued by the Lupon Chairman in this case.
________________________-
(Date)
___________________________
KP Form No. 24
JACKUELINE A. UNABIA________ Barangay Case No.: _10-2013___

-against-
MERCY G. BONJOC________________
Respondent
NOTICE OF HEARING
(RE: MOTION FOR EXECUTION)
TO : JACKUELINE A. UNABIA_________ MERCY G. BONJOC _________________

You are hereby required to appear me on _14th_ day of __October __, 2013 at _2:00 o`clock in
the morning/afternoon/evening for the hearing of the motion for execution, copy of which is attached
hereto, filed by _____ JACKUELINE A. UNABIA ___________________________.
(name of complainant/s/respondent/s)
______________________________________
(Date)
MA. MINDA D. BARRIENTOS____

Notified this ______ day of ____________________, 2013.

____________________________________ ____________________________
KP Form No. 24
GUILLERMA M. CASQUEJO_____ Barangay Case No.:_31-2007_____

Complainant/s For : Collection of debt_________
-against-
MARIETTA E. ASIS____________
Respondent/s
NOTICE OF HEARING
(RE: MOTION FOR EXECUTION)
TO : GUILLERMA M. CASQUEJO________ MARIETTA E. ASIS_________________

You are hereby required to appear me on _12th_ day of __February __, 2007 at _10:00 o`clock in
the morning/afternoon/evening for the hearing of the motion for execution, copy of which is attached
hereto, filed by _____GUILLERMA M. CASQUEJO___________________________.
(name of complainant/s/respondent/s)
______________________________________
(Date)
FERDINAND G. DAGUIPA______
Notified this ______ day of ____________________, 2008.
____________________________________ ____________________________
KP Form No. 25

_GUILLERMA M. CASQUEJO ________ Barangay Case No. :__31-2007___

Complainant/s For : Collection of debt_________
-against-
_MARIETTA E. ASIS_______________
Respondent/s
NOTICE OF EXECUTION
WHEREAS, on __08-31-07 , an amicable settlement signed by the parties in the above-

(date)
Entitled case (or an arbitration award was rendered by the Punong Barangay/Pangkat ng
Tagapagkasundo);
WHEREAS, the terms and conditions of the settlement, the dispositive portion of the award, read:
Maghatag ug Php 1,000.00 sa katapusan sa February 2008 ug ang balance nga Php 1,876.00 pagabayran
Katapusan sa March 2008.
The said settlement/award is now final and executory;
WHEREAS, the party obliged _MARIETTA E. ASIS has not complied voluntarily with the
aforestated amicable settlement/arbitration award, within the period of five (5) days from the date of
hearing on the motion for execution;
NOW, THEREFORE, in behalf of the Lupong Tagapamayapa and by virtue of the powers vested
upon me and the Lupon by the Katarungang Pambarangay Law and Rules, I shall cause to be realized
from the goods and personal property of _1 unit la germania gas range the sum of __Php 2,876.00____
______________ agreed upon in the said amicable settlement (or adjudged in the said arbitration award),
have been made upon receipt hereof:
Signed this _12th day of _February 2008.
_FERDINAND G. DAGUIPA___
Punong Barangay
Copy furnished:
______________________________ ____________________________
Page No. _____
Book No. _____
RECORD BOOK OF BRGY. CASES
(Under Katarungang Pambarangay PD. No. 1508)
I – TITLE
_ESTRELLA B. CUIZON_______________ Barangay Case No. __13-2009_____
_____________________________________ For : ___Collection of debt________
Complainant/s
-against-
_____________________________________
_____________________________________
Respondent/s
II – MEDIATION/CONCILIATIONAL FUNCTIONS
Summons served by: __Irenia G. Capilitan___________ Date served : _July 13, 2009______
Subpoena served by: ____________________________ To: _________________________
Answer filed by: _______________________________ By: _________________________
Counter-claim filed by: __________________________ By: _________________________
Cross-party complaint filed on: ____________________ By: _________________________
Third-party complaint filed on: ____________________ By: ________________________
Date/s for Mediation: _July 14, 2009________________
Date/s for Conciliation: __________________________
Date/s for Arbitration: ___________________________
III – DISPOSITION OF CASE
(Please check appropriate box)
___x___ Mediated by Brgy. Captain ______ Notice to choose Pangkat Member
_______ Arbitrated by Brgy. Captain ______ Conciliated by Pangkat
_______ Settlement Repudiated ______ Arbitrated by Pangkat
_______ Certificate to file action ______ Petitioned for Annulment of Award
_______ Forwarded to court/Gov`t Office ______ Certificate to Bar Action/Counter-claim
_______ Case Dismissed ______ Others (see remarks)
List of Settlement/Arbitration Award: ______________________________________________________
_____________________________________________________________________________________
IV – MONITORING
Monitored Nature of Case Status of Case
_July_________ _______ Criminal ___x___ Mediated ________ Conciliated

___x__ Civil _______ Arbitrated ________ Dismissed
_______ Others _______ Pending ________ Forwarded to court/
Gov`t Office
____________________________
Remarks
_____________________________
Certified Correct:
MARYLENE S. AGUILAR_______
Attested: Lupon Secretary
__FERDINAND G. DAGUIPA___
Page No. _____

Book No. _____
RECORD BOOK OF BRGY. CASES
(Under Katarungang Pambarangay PD. No. 1508)
I – TITLE
_ __ _______________ Barangay Case No. _____________
_____________________________________ For : _________________________
Complainant/s
-against-
_____________________________________
_____________________________________
Respondent/s
II – MEDIATION/CONCILIATIONAL FUNCTIONS
Summons served by: ____________________________ Date served : _________________
Subpoena served by: ____________________________ To: _________________________
Answer filed by: _______________________________ By: _________________________
Counter-claim filed by: __________________________ By: _________________________
Cross-party complaint filed on: ____________________ By: _________________________
Third-party complaint filed on: ____________________ By: ________________________
Date/s for Mediation: ____________________________
Date/s for Conciliation: __________________________
Date/s for Arbitration: ___________________________
III – DISPOSITION OF CASE
(Please check appropriate box)
_______ Mediated by Brgy. Captain ______ Notice to choose Pangkat Member
_______ Arbitrated by Brgy. Captain ______ Conciliated by Pangkat
_______ Settlement Repudiated ______ Arbitrated by Pangkat
_______ Certificate to file action ______ Petitioned for Annulment of Award
_______ Forwarded to court/Gov`t Office ______ Certificate to Bar Action/Counter-claim
_______ Case Dismissed ______ Others (see remarks)
List of Settlement/Arbitration Award: ______________________________________________________
_____________________________________________________________________________________
IV – MONITORING
Monitored Nature of Case Status of Case
_____________ _______ Criminal _______ Mediated ________ Conciliated

______ Civil _______ Arbitrated ________ Dismissed
_______ Others _______ Pending ________ Forwarded to court/
Gov`t Office
____________________________
Remarks
_____________________________
Certified Correct:
MARYLENE S. AGUILAR_______
Attested: Lupon Secretary
__FERDINAND G. DAGUIPA___

EDUARDO G. DURANGO__________ Barangay Case No.: _39-2007__

LOURDES D. ASIS________________ For: __Maltreatment/Harassment/
Complainant/s Grave Slander___________
Date: November 13, 2007_____
-against- Time: 2:00 PM______________
ALAN B. ASIS____________________
LETECIA A. FAMADOR___________
Respondent/s
P R O C E E D I N G S
(First Mediation Hearing)
I - Prayer
II - The complaint was read as follows “Pagsulti ni Alan ug Letecia

Kanako nga paulion ko (Lourdes) sa amo ug ibilin ang mga bata kay wala koy ibuhi kay
ug dili ko muuli kaladkaron ko pagawas ug pagsulong ni Letecia sa among balay didto sa
Brgy. Pagatpatan, Butuan City ug pagsulti kanamo (Eduardo and Lourdes) nga patay
gutom me adtong Nov. 10, 2007 sa alas dos sa hapon kapin kulang”.
The Chairman requested Mrs. Famador to answer first about the allegation made
by Mrs. Asis and Mr. Durango. Mrs. Famador refused she told about “ kaladkaron”. She
knew that Mrs. Asis had a loan in Green Bank last April 15, for payment of debts and the
rest of the money was expended for shopping. She knew further that on Sept. 28, the ring
was stolen and pawn. On October 13, the bracelet was pawn in the amount of Php
6,500.00. Another pawn jewelry was necklace in the amount of Php 7,000.00. Mr. Asis
seconded that he never told about “kaladkaron siya pagawas”.
Mrs. Asis said that on Nov. 9, Friday, 10:00 PM more or less, Mrs. Famador told
her, “Nene return to your home and work”. On Saturday, November 10, 8:00 AM, Mrs.
Famador said “Nene if you return home, don`t bring the children. It is better you will
return to your home and leave the children coz you can`t feed and support them. Mrs.
Asis told that Mrs. Famador said that after lunch they will bring her back home. Mrs.
Asis planned to go home first in her place at Brgy. Pagatpatan and she did it.
The Chairman asked Mr. Asis his relation to Mrs. Asis? Mr. Asis answered his
wife and legally married.
The Chairman asked why Mrs. Famador intervened the dispute?
Mrs. Famador answered that Mr. Asis informed her about the pawn jewelries.
She was the provider of Mr. Asis family and knew Mrs. Asis easily expended the money
from pawn jewelries for shopping, going to Jollibee and buying T-shirts for the children.
She questioned Mrs. Asis as easy as that?
1
The Chairman asked Mr. Durango what he could say about the situation of the
couple.
Mr. Durango, the father of Mrs. Asis decided to get his daughter and his
grandchildren since he knew that from the beginning of their marriage and living
together, they didn`t come into a harmonious relationship.
The Chairman clarified Mrs. Asis in what way she was maltreated?
Mrs.Asis answered in the way of telling her to return home and leave her two
children.
The Chairman asked again to Mrs. Asis in what way they were harassed?
Mrs. Asis answered when Mrs. Famador reached to Barangay Pagatpatan and
shouted them with many listeners.
The Chairman asked the third question in what way there was a grave slander?
Mrs. Asis answered in the way of telling her, she can`t feed and support the
children and telling them as “patay gutom”.
Mrs. Famador strongly didn`t accept she told them as “patay gutom”.
Mrs. Asis insist that in the same terminology of “patay gutom”.
The Chairman discussed the intention of hearing to have a legal

separation/annulment and support of the children.
Mr. Durango told that his daughter and Mr. Asis will separate and he ask the
latter to support the children.
Mr. Asis refused to support the children since he was just supported by his sisters.
He added that he had no job.
The Chairman decided to set a second hearing on December 4, 2007.
Mrs. Asis requested before the end of hearing to get her personal things left in the
house of Mr. Asis and witnesses that can witness the things she will get.
The Chairman granted her request.
Certified true & correct:
MARYLENE S. AGUILAR
Lupon Secretary
Attested:
Lupon Chairman
2

Date : December 4, 2008______
-against- Time : __2:00 PM____________
ALAN B. ASIS____________________
Respondent/s
(Second Mediation Hearing)
I. - Prayer
II - The Chairman review the proceedings of the first mediation hearing. Mrs. Famador
Confirmed that Mrs. Asis was instructed to return her home in the second time Mrs. Asis
pawned the necklace.
The Chair asked again why Mrs. Famador intervene the trouble. Mrs. Famador told
Mr. Asis will call her.
Mrs. Asis strongly alleged that Mrs. Famador told her “kaladkaron ko pagawas”
when her husand Mr. Asis told to his sister, Mrs. Famador if “dili siya muuli”.
Mrs. Famador insisted she didn`t told it. She said further that the root cause was to
redeem the pawn amount of Php 18,500.00.
The Chairman read again that the aim of Mr. Durango and Mrs. Asis was legal
separation and support of the children.
Mrs. Asis told that maltreatment was committed verbally.
The Chairman asked again to Mrs. Asis if she was intimadated and undergo
violence?
Mrs. Asis told she was harassed verbally.
The Chairman remark that the cause was not so complicated and admonished the
couple to reconcile.
Mr. Asis told he will reconcile if the pawn will be settled.

1
Mrs. Asis refused to reconcile and she demand the support of the children.
The Chairman repeated that harassment was done in Barangay Pagatpaatan.
Mr. Durango told that many heard the noise of Mrs. Famador loudly speaking to
them. He added that Mrs. Famador attempt to fight upon searching the children and when
Nene ( Mrs. Asis) came, truly mad and said she was the only one knew the children,
Mrs. Famador distract the chair and told “pagbantay lang mo kay naay mukuha
sa inyo diha”.
The Chairman asked Mrs. Famador if she really went to Barangay Pagatpatan.
Mrs. Famador told that it was true with certain Pastora. She said that Pastora knew
the home of Mrs. Asis parents. She met the sister of Mrs. Asis and came Mrs. Asis
telling she was the one knew where the children. Pastora advised her to go to the parents
of Mrs. Asis. They talked and Mrs. Asis told again that she was the only one knew where
the children that flare her up and stand causing the chair fall as it attached her butt when
she sat down.
The Chairman asked about the “patay gutom”.
Mr. Durango told that Mrs. Famador said “kuhaon ang mga bata kay magutman
sila”.
The Chairman concluded that the word “patay gutom” was not really spoken.
Mrs. Famador said again that the cause of trouble was the pawn jewelries.
The Chairman asked who was the owner of the jewelries?
Mrs. Famador told that her sister Leobel.
The Chairman asked Mrs. Asis why she pawned the jewelries?
Mrs. Asis told for payment of her debts.
The Chairman asked again why she took without consent?
Mrs. Asis told he would agree.
The Chairman asked Mr. Asis if he could help her wife to redeem the jewelries.
Mr. Asis told he can help if he has money.
The Chairman asked Mr. Asis about their situation as of present.
Mr. Asis told to still depart each other.
The Chairman told that next hearing is a conciliation of Pangkat since their
disputes can`t reach to settlement.
2
Page 3
Proceedings of mediation hearing
Dated 12/4/07
MARYLENE S. AGUILAR
Lupon Secretary
Attested:
Lupon Chairman

Date : December 19, 2007______
-against- Time : __2:00 PM____________
ALAN B. ASIS____________________
Respondent/s
(Conciliation Hearing)
I – Prayer
II- The Pangkat Chairman read the complaint of Mr. Durango and Mrs. Asis. He asked the
complainants if there was a possibility they can reconcile. He explained that conciliation
hearing was the last step of hearing and if failed to settle the disputes, it will be forwarded to
court.
Mrs Famador and Mr. Asis agree that will be forwarded to court.
Mr. Durango and Mrs. Asis asked a certificate to file action and minutes for elevating
the case to court.
Certified true and correct:
MANUEL B. EDULZURA
Pangkat Secretary
Attested:
AGRIPINO P. POJAS
Pangkat Chairman
BASILISA C. HUERA_____________ Barangay Case No.: _37-2007_______

________________________________ For: __Oral Defamation____________
Complainant/s ___________________________
Date : October 31, 2007___________
-against- Time : __10:00 AM_______________
GLINDA E. BALANSAG___________
________________________________
Respondent/s
I – Prayer
II –
Chairman : Mao ni imong complaint?
Mrs. Huera : O
Chairman : Tinood?
Mrs. Balansag : Tinood. Dugay name nag-away sa akong bana tungod sa iyang anak nga
Pitpit. Iyang anak maoy nagtext una sa akong bana. Ako ang nakabasa.
Chairman : Nagduda ka nga naay relasyon imong bana ug anak ni Mrs. Huera?
Mrs. Balansag : Oo.
Chairman : Naay testigo?
Mrs. Balansag : Naa.
Chairman : Pasultion nato ang mga testigos.
Peter Linugo (Unang Saksi) : Nakit-an nako sila(Felipe Balansag, Jr. ug Cristy Faith
Huera) sa menteryo nga naggakos unya misabak.
Babito Abquina( Ikaduhang Saksi) : Nangahoy ko sa menteryo bulan to sa Setyembre

nakit-an nako si Felipe Balansag Jr nagdrive sa honda motor blue,
misunod ang bae, gibira ang bae nga nagtung-tung sa pantyon.
Mrs. Huera : Gipangita nako ang kamatuoran sa pagsulti ug burikat ug giiyot-iyotan.

1
Page 2
Proceedings of 1st mediation hearing
Dated 10/31/07
Mrs. Balansag : Ubanon nako sa doctor imong anak kuhaan ug hugaw sa laki.
Chairman (nangutana ni Cristy Huera) : Tinood, naa kay relasyon sa iyang (Mrs.
Balansag) bana?
Cristy Faith Huera : Wala kay dili ko mulakaw
Chairman (Naghangyo ni Mrs. Balansag) : Dalha ang imong bana sa sunod hearing Nov.
23, 2007, 10:00 AM para makuha ang kamatuoran.
MARYLENE S. AGUILAR
Lupon Secretary
Attested:
Lupon Chairman
.
.
BASILISA C. HUERA_____________ Barangay Case No.: _37-2007_______

________________________________ For: __Oral Defamation____________
Complainant/s ___________________________
Date : November 11, 2007__________
-against- Time : __10:00 AM_______________
GLINDA E. BALANSAG___________
________________________________
Respondent/s
I – Prayer
II –
Chairman (Gi acknowledge ang presensya ni Felipe Balansag, Jr.)
Mrs. Huera : Gihangyo nako nga paistoryahon si Felipe Balansag, Jr.
Chairman(Nangutana kay Felipe Balansag, Jr.) : Nahitabo ba nga naay relasyon nimo sa
iyang anak?
Felipe Balansag, Jr. : Mao gani nangayo ko ug pasaylo sa akong asawa ug si Cristy Faith
Misulti nga nangayo na siya ug pasaylo sa iyang ginikanan. Dili ra sa
Menteryo nahitabo, didto pus sa dagat.
Mrs. Huera : Mitubag na ang akong anak wala silay relasyon. Sa wala pa ang unang
Husay diri si Felipe Balansag, Jr. miingon na nga wala silay relasyon.
Felipe Balansag, Jr. : Naingon to nako nga wala kay sige ang among away sa akong
asawa. Diri unta ang iyang anak.
Mrs. Huera : Klaro nga ebidensya nga naay nahitabo ang akong gipangita.
Chairman : Naupos na ang panahon sa mediation hearing, pangkat ang muhusay sunod.

FLORENTINO MARAYA__________ Barangay Case No.: _15-2008______

________________________________ For: __Forgery__________________
Complainant/s ___________________________
Date : March 7, 2008 _____________
-against- Time : __10:00 AM_______________
RENERIO B. SITOY_______________
________________________________
Respondent/s
I. Prayer
II.
The Chairman read the complaint that goes by “doing forgery of the waiver”. He
requested Mr. Maraya to relate the circumstances.
Mr. Maraya told he prepare a waiver of lot in Calayagon signed by him and Mr.
Jomoc but the two Elpanag brothers have no signature yet of the waiver. Mr. Sitoy
borrowed the waiver and told him to show such document to his boss. Mr. Sitoy
disappear from the time he borrowed the waiver and a sudden Mr. Elpanag came and told
him that Mr. Sabihon will use the waiver to support the case against Mr. Elpanag. He was
wondering why the waiver bears already the signature of the two Elpanag brothers.
Mr. Sitoy showed the original handwritten waiver and told that he gave only a xerox
copy to Mr. Bob.
The Chairman gave a chance to Mr. Elpanag to inquire Mr. Sitoy.
Mr. Elpanag inquired Mr. Sitoy who did the forgery of his signature.
Mr. Sitoy told “ Ilang gihimo-himuan”.
Mr. Elpanag told that Mr. Sabihon showed him the waiver with his signature already
and his brother but it was not his genuine signature. He inquired again to Mr. Sitoy if he
he was the one signing it.
Mr. Sitoy told yes.
Then, Mr. Maraya presume the consequences if they will use the waiver for the case,
what will be their actions?
Mr. Sitoy told they talked already. Mr. Maraya and Mr. Elpanag requested Mr.
Page 2
Proceedings of Case No. 15-2008
Dated 03/07/08
Sabihon and Engr. Ubungin to appear the next hearing. Mr. Sitoy agreed.
MARYLENE S. AGUILAR
Lupon Secretary
Attested/Approved:
Lupon Chairman

FEDERICO P. GORDO_____________ Barangay Case No.: _20-2009______

MARCIANA C. GORDO____________ For: __PHYSICAL INJURY_______
Complainant/s ___________________________
Date : September 4, 2009 __________
-against- Time : __2:00 PM_______________
RODOLFO PINOON_______________
________________________________
Respondent/s
I. Prayer
II.
Si Federico Gordo nag-asoy nga adtong hapona sa alas kwatro emedya, gitawagsiya ni
Rodolfo Pinoon didto sa balay ni Vallecera ug gipainom ug usa ka shot. Adtong tungura nabasa
ang iyang (Rodolfo) short ug akong gitabangan sa pag-ilis niini tungod sa kahubog. Human
niudto, miuli ko (Federico) sa balay ug naghigda-higda ug si Rodolfo miuli usab. Sa akong
paghigda-higda, mibalik si Rodolfo ug dala ang stick, akong gipugngan sa pagsaka tungod sa
bata nga natulog ug iya kong gibunal-bunalan ug miingon “pamatyon tamo tanan kay di mo
tagadinhi” nga maoy hinungdan sa pagkasamad sa agtang ug pagpangalagom pagkabun-og sa
iyang lawas ug ang medical certificate gipakita nga maalim ang bun-og ug samad sulod lamang
sa lima (5) ka adlaw.
Si Marciana Gordo nag-asoy nga duro niyang syagit ug panabang, gibira niya ang sinina
ni Rodolfo. Dugay kayo mianha ang nagtabang. Pagkahuman sa hitabo milabay ko sa ilang
(Rodolfo) balay kay muadto sa balay sa Barangay Secretary miingon “ konsentidor ka” ug
mitubag ako nga walay labot.
Ang Kapitan nangutana kang Rodolfo ngano iyang nabuhat. Si Rodolfo mitubag nga
nabuhat niya nga walay kalibutan tungod sa kahubog. Diha na siya nahibalopagkabuntag nga
gisultian siya sa iyang asawa. Misulti si Rodulfo nga wala sila sukad magkabikil o
nagkaengkwentro ni Federico hinoon sa una naghangyo-hangyo sila bahin sa yuta pero sa mga
Iting kini ug bahinunon pa sa mga igsoon ug wala siya maghawod-hawod niini.
Gisulti sa Kapitan segun sa gisang-at nga sumbong nga pabayron si Rodolfo sa mga
damage. Si Rodolfo miingon nga tubagon tanan ang pagpatambal ug mga medisina nga iresita
pero si Marciana nagdumili kay obserbahan ppa ang kahimtang sa iyang bana kay X-ray hanan ug
nagpasalig nga ilang paliton tanan tambal nga geresita ug magsugod sa pagtumar niining adlawa..
Ang Kapitan nag-ingon nga ang kasabutan magtal-tal nga ang obligasyon ni Rodolfo taman sa
maalim.
Si Rodolfo mihangyo nga dili na siya gusto nga mudako pa ug mangayo siya ug pasaylo,
musagubang sila aron dili na muadto sa taas.
Ang nagsumbong hugot nga nagdumili sa katarungan nila nga ipaabot sa itaas.

MARYLENE S. AGUILAR
Lupon Secretary
Attested/Approved:
Lupon Chairman

FEDERICO P. GORDO_____________ Barangay Case No.: _20-2009______

MARCIANA C. GORDO____________ For: __PHYSICAL INJURY_______
Complainant/s ___________________________
Date : September 8, 2009 __________
-against- Time : __2:00 PM_______________
RODOLFO PINOON_______________
________________________________
Respondent/s
I. Prayer
II.
Ang minutas sa unang husay gibasa ug si Federico midugang pagpadayag nga sa
pagkakaron nay mulingin itom inig tan-aw ang pikas mata. Ang Kapitan nag-ingon nga
gihatagan ug panahon aron sa paghunahuna unsay maayo. Midugang ug sulti si Federico
nga dili siya makig-amicable sa Barangay sa panghitabo nga siya nangusog batok sa kusog ni
Rodolfo. Si Marciana midugang usab sa pag-ingon sayunan ug milakaw pa siya mapatay
gayod ang iyang bana.
Segun sa subay ni Federico misugod siya pagtumar sa gerisita nga tambal sugod
sa gabii adtong Setyembre 4, 2009 hangtod niining adlawa Setyembre 8, 2009.
Ang Kapitan nagdesisyon nga magpili na sila sa tulo ka membro aron ang husay adto
Na sa Pangkat aron ang Pangkat na usab ang mutuki sa kahupayan.
MARYLENE S. AGUILAR
Lupon Secretary
Attested/Approved:
Lupon Chairman
SERCONSECION B. BASUBAS, et. al. Barangay Case No.: _05-2010__

_________________________________ For: __Land Disputes_________
Complainant/s Date: April 12, 2010__________
Time: 9:00 AM______________
-against-
ORONCIA B. KUIZON_____________
FELIPE C. BALANSAG, et. al._______
Respondent/s
( Mediation Hearing)
I - Prayer
II - The Chairman read the complaints and let Mrs. Basubas to express her
complaints.
Mrs. Serconsecion Basubas told she had no other purpose of bringing the case to
the Barangay was to get her share from the inherited land of their deceased parents. Same
with Fidel Balansag and Cresencio Balansag representatives of their deceased parents as
heirs also of the said inherited land.
Mrs. Letecia Famador recalled in 1945 the land was declared under Dominga
Cobal Balansag. In 1952 it was transferred to Bernardino Balansag then to Oroncia
Kuizon until 2010 paying taxes levied on land. Mr. Fidel Balansag requested the
Chairman to clarify the situation of land, he asked against the respondents to present the
documents supporting the land they occupied and dwell. Mrs. Letecia Famador suggested
to elevate the case in proper court in order to avoid further discussions and offending
their relations as relatives and there, they would present all the documents needed.
The complainants and respondents further agreed not to hold any other
mediation hearing presided by the Captain and select three Lupon members that will
constitute the Pangkat ng Tagapagkasundo that will hear them in conciliation hearing.
MARYLENE S. AGUILAR
Lupon Secretary
Attested:
Lupon Chairman
SERCONSECION B. BASUBAS, et. al. Barangay Case No.: _05-2010__

_________________________________ For: __Land Disputes_________
Complainant/s Date: April 29, 2010__________
Time: 9:00 AM______________
-against-
ORONCIA B. KUIZON_____________
FELIPE C. BALANSAG, et. al._______
Respondent/s
( Conciliation Hearing)
I - Prayer
II - The Pangkat Chairman read the complaints of Mrs. Basubas, et. al. and review
the mediation proceedings.
As recap, Mrs. Serconsecion Basubas told it was her long time request to
get the share of land she entitled to inherit from her deceased parents also her nephews of
her deceased brothers.
Pangkat Chairman Pojas asked the statement of Mr. Raul Kuizon. Mr. Raul
Kuizon requested the documents of this land from the complaints and he suggested to
forward this case to the proper court.
MANUEL B. EDULZURA
Pangkat Secretary
Attested:
AGRIPINO P. POJAS
Pangkat Chairman
Day : Sunday
Date :
Time started :
Number of members for quorum :
Call to Order:
The meeting was called to order at o`clock in the morning with a minute prayer led by
Roll Call:
The roll was called and the following persons are:
Present: Absent:
1.
Quorum:
Agenda:
Adjournment:
There being no business taken the meeting adjourned at
Certified true and correct:
MARYLENE S. AGUILAR
Lupon Secretary
Attested/Approved:

Presiding/Acting Lupon Chairman
Repulic of the Philippines
PROFILE OF LUPON MEMBER
REGION : 13 CARAGA
POSITION : Lupon member
I. PERSONAL INFORMATION
SURNAME : _____________________________________________________________
FIRST NAME : _____________________________________________________________
MIDDLE NAME : _____________________________________________________________
NICK NAME : _____________________________________________________________
DATE OF ASSUMPTION/APPOINTMENT: ________________________________________

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OFFICE OF THE PUNONG BARANGAY

NOTICE TO CONSTITUTE THE LUPON

TO ALL BARANGAY MEMBERS AND ALL OTHER PERSONS CONCERNED:

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MA. MINDA D. BARRIENTOS

OFFICE OF THE PUNONG BARANGAY

TO : _HENRY S. DELA CERNA

MA. MINDA D. BARRIENTOS

OFFICE OF THE PUNONG BARANGAY

January 25, 2013

OFFICE OF THE PUNONG BARANGAY

MA. MINDA D. BARRIENTOS

OFFICE OF THE PUNONG BARANGAY

December 27, 2013

HENRY S. DELA CERNA

Very truly yours,

OFFICE OF THE PUNONG BARANGAY

__December 27, 2014

Very truly yours,

OFFICE OF THE PUNONG BARANGAY

LIST OF APPOINTED LUPON MEMBERS

Tearing or defacing this notice shall be subject to punishment according to law.

OFFICE OF THE PUNONG BARANGAY

LIST OF APPOINTED LUPON MEMBERS

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Tearing or defacing this notice shall be subject to punishment according to law.

OFFICE OF THE PUNONG BARANGAY

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MA. MINDA D. BARRIENTOS

OFFICE OF THE PUNONG BARANGAY

OFFICE OF THE PUNONG BARANGAY

OFFICE OF THE LUPONG TAGAPAMAYAPA

= Incapacity to discharge the duties of your office as shown by __________________________

= Unsuitability by reason of _____________________________________________________

Received this ______ day of ___________________, 2006.

OFFICE OF THE LUPONG TAGAPAMAYAPA

______________________ _________ _____ Barangay Case No.: _________________

Made this ____th day of _______ , year ______.

Received and filed this _____th day of ________ , _______.

OFFICE OF THE LUPONG TAGAPAMAYAPA

TEODOLO G. BINOLIRAO__ _________ __ Barangay Case No.: ___11-2010_______

Dili na utruhon ang kasamok.

Made this 2nd day of June , year 2010.

Received and filed this 2nd day of June , 2010.

OFFICE OF THE LUPONG TAGAPAMAYAPA

JULIETA O. BINOLIRAO___ _________ __ Barangay Case No.: ___12-2010_______

TEODOLO G. BINOLIRAO _____________________

Sa dili paghatag ug tarong sustento sa among anak nga nia kanako

Sustentuan ang mga bata.

Made this 2nd day of June , year 2010.

Received and filed this 2nd day of June , 2010.

OFFICE OF THE LUPONG TAGAPAMAYAPA

ROBERTO D. LUMBAY, SR.___ _________ Barangay Case No.: ___13-2010_______

TEODOLO G. BINOLIRAO _____________________

Made this 21st day of June , year 2010.

Received and filed this 2nd day of June , 2010.

OFFICE OF THE LUPONG TAGAPAMAYAPA

JULITA S. SEMBLANTE______ _________ Barangay Case No.: ___14-2010________

BENIGNA P. TABANAO ____________________

Made this 27th day of July , year 2010.

Received and filed this 27th day of July , 2010.

Received this day of _____________, 2006.

________________ _ _ Barangay Case No.: _______________

Made this th day of _ , year ____.

Received and filed this _th day of , ___.

TEODOLO G. BINOLIRAO _____ Barangay Case No.: _11-2010_____

JULIETA O. BINOLIRAO_ _____ Barangay Case No.: _12-2010_____

ROBERTO D. LUMBAY, SR._ _____ Barangay Case No.: _13-2010_______

JULITA S. SEMBLANTE _ Barangay Case No.: _14-2010________

This ____ day of _ _____.

______. Barangay Case No.: _

This _ day of _ _, ______

JULITA S. SEMBLANTE ________________ Barangay Case No.: _14-2010_______

CARMELA T. GULAY ______________ Barangay Case No.: _10-2010_______

SERCONSECION BASUBAS, et. al. ____ Barangay Case No.: 05-2010_

TO:_SUSAN P. MANTILLA_ RICO B. KUIZON_______

Notified this day of ________, 2010.

_SERCONSECION BASUBAS, et. al._____ Barangay Case No. : _05-2010______

April 27, 2010____________

Received this day of ___________, 2010.

_SERCONSECION BASUBAS, et. al. _____ ORONCIA KUIZON, FELIPE _

Notified this day of __________, 2010.

_____________________ Barangay Case No.:

TO: __

This day of , ____.

_______________________ Barangay Case No.:

Entered into this _ day of ____________, 2006.

__________________ Barangay Case No. _

Made this _ day of , 2006 at __________.

_ROBERTO LUMBAY, SR. .________ Barangay Case No.: _06-2010___

_GUARITA ADELANTAR_________ Barangay Case No.: _25-2009___

_JEAN P. OCLARIT_________ Barangay Case No.: _04-2010_________

_SUSAN P. MANTILLA________ Barangay Case No.: _03-2010_________