Republic of the Philippines

Province of
MUNICIPALITY OF
Barangay

OFFICE OF THE LUPONG TAGAPAMAYAPA

PETER CURTIS and

ANNE CURTIS Barangay Case No.
Complainants, For: Grave Threat

--- against ---

JUAN DELA CRUZ

Defendant.

COMPLAINT

We hereby complain against above named defendant for violating our rights and
interests in the following manner:

1. That on the morning of February 1, 2010 defendant came to our residence and had
forcefully entered our house.
2. That on the said date and incident, defendant had shouted at my wife Anne and told her
“Patyon tikawng chismosaha ka” while pointing his (sundang) to my wife.
3. That on the afternoon of the aforementioned date while we are walking in front of the
Barangay Hall, defendant had brought the sundang and pointed it to us while shouting
“Patyon tamo, pang tagud taguron mo nako para mahilom na inyung baba”.
4. That defendant is a resident of this barangay, Barangay ________, and the complainants
are likewise located in the same barangay, making the instant complaint cognizable and
under the jurisdiction of Brgy. __________, Municipality of _____________, as provided
for under R.A. 7610.

THEREFORE, WE pray that the following reliefs be granted to us in accordance with the law
and/or equity.

1. That respondent JUAN DELA CRUZ be made to appear before the Lupong Tagapamayapa
of Brgy. ________.
2. That after the notice and hearing, respondent be directed to avoid contact with the
complainants.
 3. Other reliefs just and equitable are likewise prayed for.

Made this 5th day of February, 2010.

PEDRO CURTIS
Complainant

ANNE CURTIS
Complainant

Received and filed this 5th day of February, 2010.

LYLE JOSEPH S. BUCOL

Punong
Barangay/Lupon
Chairman