Republic of the Philippines

Province of Cagayan
Municipality of Buguey
BARANGAY MINANGA ESTE

OFFICE OF THE LUPONG TAGAPAMAYAPA

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_____________________________________ Barangay Case No.

Complainant/s _______________________

— against — For:
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Respondent/s

COMPLAINT
I/WE hereby complain against above named respondent/s for violating my/our rights and
interests in the following manner:

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THEREFORE, I/WE pray that the following relief/s be granted to me/us in accordance with
law and/or equity:

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Made this _______ day of ___________, 20___.

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Complainant/s

Received and filed this ________ day of __________, 20____.

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Punong Barangay/Lupon Chairman