Philippine National Police

IRF ENTRY NUMBER : TYPE OF INCIDENT : (Incident) Physical Injury COPY FOR :

076210-202105-00911952 FRUSTRATED HOMICIDE COMPLAINANT

INSTRUCTIONS: Refer to PNP SOP on Recording of Incidents in the Police Blotter in filling up this form. This Incident Record Form (IRF) may be reproduced, photocopied, and/or
downloaded from the DIDM website, www.didm.pnp.gov.ph.
DATE AND TIME REPORTED : DATE AND TIME OF INCIDENT : PLACE OF INCIDENT: BARANGAY, TOWN/CITY, PROVINCE :

2021-05-09 04:00:00 2021-05-08 22:30:00 Quiot Pardo, Police Station 10 (PUNTA PRINCESA), CEBU CITY
ITEM "A" - REPORTING PERSON
FAMILY NAME : FIRST NAME : MIDDLE NAME : QUALIFIER : NICKNAME :

CITIZENSHIP : GENDER : ADDRESS :

ITEM "B" - SUSPECT'S DATA

FAMILY NAME : FIRST NAME : MIDDLE NAME : QUALIFIER : NICKNAME :

Vellieflor Madden Lapot Unidentified

CITIZENSHIP : GENDER : CIVIL STATUS : DATE OF BIRTH : AGE : PLACE OF BIRTH :

FILIPINO M Single 39
ADDRESS (HOUSE NUMBER/STREET) VILLAGE/SITIO: BARANGAY : TOWN/CITY : PROVINCE :

San Caros Village Labangon Police Station 10 (PUNTA PRINCESA) CEBU CITY
HIGHEST EDUCATIONAL ATTAINMENT : OCCUPATION : RELATION TO VICTIM :

none
RANK (IF AFP/PNP PERSONNEL) : UNIT ASSIGNMENT : GROUP AFFILIATION : WITH PREVIOUS CRIMINAL RECORD : STATUS OF PREVIOUS CASE :

NO
HEIGHT : WEIGHT : COLOR OF EYES : COLOR OF HAIR : DISTINGUISHING MARKS : UNDER THE INFLUENCE :

FOR CHILDREN IN CONFLICT WITH THE LAW

NAME OF GUARDIAN : GUARDIAN ADDRESS :

ITEM "C" - VICTIM'S DATA

FAMILY NAME : FIRST NAME : MIDDLE NAME : QUALIFIER : NICKNAME :

Sabas Clifford Ewican Unknown

CITIZENSHIP : GENDER : CIVIL STATUS : DATE OF BIRTH : AGE : PLACE OF BIRTH : PHONE NUMBER :

FILIPINO M Single 23 none

ADDRESS (HOUSE NUMBER/STREET) VILLAGE/SITIO: BARANGAY : TOWN/CITY : PROVINCE :

Brgy. Sapangdaku, Guadalupe Cebu City Sapang-Dako Police Station 9 (GUADALUPE) CEBU CITY
HIGHEST EDUCATIONAL ATTAINMENT : OCCUPATION : RELATION TO SUSPECT :

none
 ITEM "D" - NARRATIVE OF INCIDENT
DATE AND TIME REPORTED : DATE AND TIME OF INCIDENT : PLACE OF INCIDENT: BARANGAY, TOWN/CITY, PROVINCE :

2021-05-09 04:00:00 2021-05-08 22:30:00 Quiot Pardo, Police Station 10 (PUNTA PRINCESA), CEBU CITY, CEBU CITY
THE NARRATIVE OF THE INCIDENT OR EVENT, ANSWERING THE WHO, WHAT, WHEN, WHERE, WHY AND HOW OF REPORTING.

Arrested Person for Viol. of Frustrated Homicide

Where : Place of incident: San Carlos Village, Brgy. Quiot, Cebu City

When : TDI: 10:30 PM more or less of May 8, 2021

TDR: 11:10 PM more or less of May 8, 2021

Who : Suspect: Vellieflor Lapot Madden, 39 years old, female, fil., resident of San Caros Village, Brgy. Labangon, Cebu City.

Victim: Clifford Ewican Sabas, 23 years old, male, fil., single, resident of Brgy. Sapangdaku, Guadalupe, Cebu City

Assisting officers: B/T Noli Trasona, B/T Piter Tabanas, Elmer Labapes, and Elizardo Rago

How/Why: Initial investigation revealed that the suspect went to their lease property (rooms). One of which, was occupied by the victim
(Mr. Mark Tecson) and Clifford Sabas. Allegedly, the victim confronted the suspect regarding their agreement in the Barangay, that to
lease the next adjoining room only when they vacate from their rented room because of their dogs which may posed danger to other
tenants since it can only easily go outside their room due to the damage door. They exchanged heated arguments which resulted to a
clamor and they physically hurting each other. When the victim and the suspect arrived near the entrance gate, the former noticed that
he had blood in his left hand due to a laceration by an identified object.

The Victim immediately went to the Barangay Hall of Quiot, Cebu City and asked for Tanod?s assistance. At the Barangay Hall, the
victim discovered that he incurred one stab wound on the left side of his stomach, one stab wound on his left Arm, one lacerated wound
on his left hand, one lacerated wound on his right toe, and one lacerated wound on his right ankle.

The victim was immediately brought to the CCMC Hospital for immediate medical treatment. On the other hand, the suspect was
brought to this office and was appraise of her offense as well as her constitutional rights as an arrested person.
The suspect was also brought to Cebu City medical Center for Medical and Physical Check-up.

I HEREBY CERTIFY TO THE CORRECTNESS OF THE FOREGOING NAME OF REPORTING PERSON : SIGNATURE OF REPORTING PERSON :
TO THE BEST OF MY KNOWLEDGE AND BELIEF.

SUBSCRIBED AND SWORN TO BEFORE ME NAME OF ADMINISTERING OFFICER(DUTY OFFICER) : SIGNATURE OF ADMINISTERING OFFICER(DUTY OFFICER) :

RANK, NAME AND DESIGNATION OF POLICE OFFICER (WHETHER HE/SHE IS THE DUTY SIGNATURE OF DUTY INVESTIGATOR/INVESTIGATOR ON CASE/ASSISTING POLICE OFFICER :
INVESTIGATOR, INVESTIGATOR ON CASE OR THE ASSISTING POLICE OFFICER)

RANK/NAME OF DESK OFFICER: SIGNATURE OF DESK OFFICER : BLOTTER ENTRY NR:

INCIDENT RECORDED IN THE BLOTTER BY:

REMINDER TO REPORTING PERSON

Keep the copy of this Incident Record Form (IRF). An update of the progress of the investigation of the crime or incident that you reported
will be given to you upon presentation of this IRF. For your reference, the data below is the contact details of this police station.

Name of Police Station PS 10 (PUNTA PRINCESA), CEBU CPO, PRO 7 Telephone 3281497

Investigator-on-Case PCPL KEITH VINCENT GABICA Mobile Phone 3281497

Name of Chief/Head of Office JANELITO JUCSON MARQUEZ Mobile Phone 09052516985