Republic of the Philippines

Province of Ilocos Norte

Municipality of Paoay
BARANGAY 12 SAN BLAS

OFFICE OF THE LUPONG TAGAPAMAYAPA

Mrs. Marivic Javier Barangay Case No. : 003

Brgy 12 San Blas , Paoay, I.N. For : Assault to a Person in Aide to Authority
Complainant/s

-againsts-

Mr. Windel Semana

Brgy. 12 San Blas, Paoay, I.N.
Respondent/s

SUMMON

TO: Mrs. Marivic Javier

You are hereby summoned to appear before me in person, together with your
witnesses, on the ______ day of ____________________ 2020 at _____ o’clock in the
afternoon, then there to hear and settle the complaint made before me, copy of which is
attached hereto, for mediation/conciliation of your dispute with respondent/s.

You are hereby warned that if you refuse or willfully fail to appear in obedience to this
summons, you may be barred from filing any counterclaim arising from said complaint.

This _________ day of ___________________ 2020.

CLEMENCE D. POBRE
Punong Barangay/ Lupon Chairman