FORM NO.

57 -- MALVERSATION

INFORMATION

   
      The undersigned accuse……………………………………………….....of the crime
of Malversation of Public Funds defined and penalized under ART 217 of the Revised
Penal Code, committed as follows

      That on or about the ……………....day of ……………....19........ in the Municipality

of………………………………………......Province of ...............................................and
within the jurisdiction of this Hon.  Court, the said accused , while serving  9in the
capacity of Acting Collection Agent of the Municipality of…………………………... did
then and there willfully unlawfully , and feloniously , and with grave abuse of
confidence, misappropriate , take and withdraw , for his own use and benefit , the total
cash collections for the month of ...................................................of the municipality , in
the n of............................................Philippine Currency, and thus . was found the damage
and prejudice if the public interest.

Contrary to law
..........19……………..
                       ..........................................
                    Provincial fiscal

 Witnesses:
………………………………….
………………………………..