Republic of the Philippines

Province of Tarlac
Municipality of Moncada
BARANGAY CAMPOSANTO 1 NORTE

OFFICE OF THE LUPON TAGAPAMAYAPA

SUMMONS

TO:

You are hereby summoned to appear before me in person, on the ___ day
of______________ ,20____ at _________ in the morning/afternoon.

You are hereby warned that if you refuse or wilfully 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 __________, 201__.

Hon. Agapito G. Benitez

Punong Barangay

Received by:

Signature over printed name

To the officer :
Please let the respondent/receiver to sign as proof that they had received this summons.