Jurists Bar Review Center™: Sample Forms For Criminal Law Practical Exercises

JURISTS BAR REVIEW CENTER™
SAMPLE FORMS FOR CRIMINAL LAW

PRACTICAL EXERCISES
SAMPLE FORM NO. 1: Case covered by the Rules of Summary Procedure (Direct
filing in MTC)
Republic of the Philippines

Fourth Judicial Region
MUNICIPAL TRIAL COURT IN CITIES
Branch
Nueva York City
THE PEOPLE
OF THE PHILIPPINES,
Plaintiff. CRIMINAL CASE NO.
- versus - for
KAREN MARITES, ORAL DEFAMATION

Accused.
x---------------------------------x
INFORMATION
The undersigned Assistant City Prosecutor, upon complaint under oath by the
offended party hereby accuses Karen Marites for the crime of Oral Defamation, defined and
penalized under the provisions of Article 358 of the Revised Penal Code as amended by
Republic Act No. 10951, committed as follows:
That on or about July 4, 2018 at around 6:30 in the evening at Brgy. Starlight East, ,
Nueva York, Philippines and within the jurisdiction of this Honorable Court, the above-
named accused, with intent to impeach the honor, integrity and reputation of Jessica Jones,
did then and there willfully, unlawfully and feloniously utter to her the following defamatory
words, to wit: ““PUTANG INA MO! IKAW ANG PINAKAHAYOP DITO! PUTANG INA
MO!” and other words of similar import in the presence of other persons, thereby exposing
the offended party to public hatred, humiliation, contempt and ridicule.
CONTRARY TO LAW.
Nueva York, August 1, 2018
EGAN ENRIKEZ
Assistant City Prosecutor
MCLE Compliance No. VI-XXX/ April 11, 2019
Roll of Attorneys No. 5XXX
CERTIFICATION
This is to certify that as represented, the provisions of Chapter 7, Section 412 of

Republic Act 7160 (Local Government Code of 1991) had been complied with per attached
Jurists Sample Forms for Practical Exercises. For exclusive use of Jurists Bar reviewees. © 2022 by Jurists
Review Center, Inc. Unauthorized copying, dissemination, sharing, uploading, downloading, and storage strictly
prohibited and will be prosecuted to the full extent of the law, including the filing of administrative complaints
with the Office of the Bar Confidant, IBP, and SC as well as the filing of
criminal charges. Page 1 of 19
Certification dated July 28, 2018 issued by the Pangkat Secretary of the Lupong
Tagapamayapa of Barangay Starlight, Nueva YorkCity duly attested by the Pangkat
Chairman.
EGAN ENRIKEZ
SUBSCRIBED AND SWORN to before me this 9th day of November, 2020 at

Nueva York City.
MIKE CLABYO‘
MCLE Compliance No. VI-YYYY2/March 21, 2018
Roll of Attorneys No. 4YYYY
WITNESSES:
Jessica Jones, Angle Subd., Brgy. Flora, Nueva York City;

Pat Mikey Mouse, Offiecr-On-Case, PNP, BCPS, Nueva York City;
And OTHERS.
Address of Accused: Brgy. Starlight, Nueva York City – at large –
BAIL UNNECESSARY UNLESS REQUIRED BY THE COURT:
APPROVED:
MEEH TYANCO
City Prosecutor
MCLE Compliance No. VI-AAAJuly 20, 2018
Roll of Attorneys No. 4-AAA
SAMPLE FORM NO. 2. Criminal Complaint (Direct Filing in MTC)

MUNICIPAL TRIAL COURT
San Jose, Batangas
THE PEOPLE
OF THE PHILIPPINES,
- versus - for
RUDOLP RANDEER, RECKLESS IMPRUDENCE

CAUSING Accused. DAMAGE TO PROPERTY
x--------------------------------------------x
CRIMINAL COMPLAINT
The undersigned Chief of Police hereby accuses Rudolp Randeer of the crime of
Reckless Imprudence Causing Damage to Property, defined and penalized under Article 365
of the Revised Penal Code as amended by Republic Act No. 10951, committed as follows:
That on or about January 14, 2010 at around 6:55 in the morning along National
Highway, Brgy. Eagle South, San Jose, Batangas, Philippines and within the jurisdiction of
this Honorable Court, the above-named accused, being then the driver and registered owner
of a Yamaha Mio Aerox motorcycle bearing MV File No. 4XXX-111, without exercising
due care and precaution to avoid damage to property, without considering the condition and
visibility of the road and the presence of other vehicles thereat, did then and there unlawfully,
carelessly and imprudently drive and operate said Yamaha Mio Aerox motorcycle at a speed
greater than that ordinarily allowed by law, and as a result of such carelessness and gross
negligence, the front portion of the said Yamaha Mio Aerox motorcycle bumped and hit the
right side portion of a sari-sari store owned Francer Meeh, thereby causing damage to said
sari-sari store in the amount of Fifty Thousand Pesos (Ph50,00.00), Philippine Currency, to
the damage and prejudice of the said owner in the aforementioned amount.
CONTRARY TO LAW.
Province of Batangas, March 30, 2010.
SP02 Nicholas Claus

Chief of Police
San Jose MPS
SUBSCRIBED AND SWORN TO BEFORE ME, this day of 30 March 2010 in San
Jose, Batangas.
SP01 Glimi Elfe

Chief Investigator
San Jose MPS
BAIL RECOMMENDED: Php17,000.00

/mdh…
SAMPLE FORM NO. 3. INFORMATION (Filed before MTCC)

Branch
Nueva York City
THE PEOPLE
OF THE PHILIPPINES,
- versus - for
JULIAN MAINITIN , RECKLESS IMPRUDENCE RESULTING

Accused. IN SERIOUS PHYSICAL INJURIES
x---------------------------------x
INFORMATION
The undersigned Assistant City Prosecutor hereby accuses Julian Mainitin for the
crime of Reckless Imprudence Resulting in Serious Physical Injuries, defined and penalized
under Article 365 of the Revised Penal Code, committed as follows:
That on or about August 27, 2018 at around 1:30 in the early morning at National
Road, Brgy. Copper Plain, Nueva York City, Philippines and within the jurisdiction of this
Honorable Court, the above-named accused, being then the driver, and person-in-charge of a
Suzuki Wagon bearing conduction sticker FEU 5XXX, registered in the name of Juanito Ito
of Apple Seed, Nueva York City, without exercising due care and precaution to avoid
injuries to person, without considering the condition and visibility of the road and the
presence of other vehicles thereat, did then and there unlawfully, carelessly and imprudently
drive and operate said Suzuki Wagon at a speed greater than that ordinarily allowed by law,
and as a result of such carelessness and gross negligence, said Suzuki Wagon bump and hit
the right leg of one Kapitani Hook who was then a back rider of a Yamaha Mio Sporty
motorcycle bearing MV No. 2XXX driven at that time by Lito Lisensya, and owned and
registered in the name of Kapitani Hook of Brgy. Copper Plain, Nueva York City, thereby
causing serious physical injuries to said Kapitani Hook, to wit: Shoulder (R) dislocation;
Upper arm (R) concussion”
which injuries required him medical attendance for a period of more than thirty (30) days
and incapacitated the offended party for the same period of time.
That the accused failed to lend on the spot to the victim such help as may be in his
hands to give, is a qualifying circumstance attendant in the commission of the offense.
That at the time of the incident accused was in the discharge of his duties as an
authorized driver of the registered owner of Suzuki Wagon.
CONTRARY TO LAW.
Nueva York City, October 3, 2018.
Pedrito Paulo
MCLE Compliance No. V-11111/ February 13, 2017
Roll of Attorneys No. 42424
CERTIFICATION
This is to certify that a preliminary investigation of this case was conducted and as
shown by the record, an authorized officer has personally examined the complainant and
his/her witnesses and from the evidence submitted, the undersigned believes that the crime
charged was committed and there is a reasonable ground to believe that accused herein is/are
probably guilty thereof.
It is further certified that a notice of complaint was sent to the accused at his/her
known address, together with the evidence against him/her and he/she was given the
opportunity to submit controverting evidence.
Pedrito Paulo
SUBSCRIBED AND SWORN to before me this 3rd day of October, 2018 at Nueva
York City.
Juan Pablo
Associate City Prosecutor
MCLE Compliance No. V-2222 / March 21, 2016
WITNESSES:
1. Kapitani Hook, Brgy. Copper Plain, Nueva York City;

2. Lito Lisensya, -do-
3. SPO1 Juan Parak Officers-on-Case,
PNP, NYCPS, Nueva York City;
4. Dr. Wyatt Earp, Wild West Hospital, Nueva York City
Address of Accused: Brgy. Copper Plain, Nueva York City - at large –
APPROVED:
Brenda Starr
City Prosecutor
MCLE Compliance No. V-333/ March 15, 2016
SAMPLE FORM NO. 4. Information for BP 22

Branch
Nueva York City
THE PEOPLE
OF THE PHILIPPINES,
- versus - for
DONALD DUCK, VIOLATION OF B.P. BLG. 22

Accused.
x-----------------------------------x
INFORMATION
The undersigned Assistant City Prosecutor hereby accuses Donald Duck for violation
of Batas Pambansa Blg. 22, committed as follows:
That on or about March 12, 2014 at Nueva York City, Philippines and within the
jurisdiction of this Honorable Court, the above-named accused, well-knowing that she does
not have sufficient funds in or credit with the LDR Long Distance Bank, Makati Branch,
Makati City, did then and there knowingly, willfully, and criminally draw, make and issue to
Mickey Mouse LDR Check No. 00XXX dated March 12, 2014 in the amount of THREE
HUNDRED THOUSAND PESOS (Php300,000.00), Philippine Currency, to apply on
account or for value, but when said check was presented for full payment with the drawee
bank, within the period of ninety (90) days from the date of the check, the same was
dishonored by the drawee bank on the ground of “ACCOUNT CLOSED”, and despite notice
of dishonor and demands made upon her to make good her check by making proper
arrangement with the drawee bank or pay her obligation in full directly to Mickey Mouse,
accused failed and refused to do so, which acts constitute a clear violation of the afore-cited
law, to the damage and prejudice of transactions in commercial documents in general and of
Mickey Mouse, in particular, in the aforementioned amount.
CONTRARY TO LAW.
Nueva York City, April 16, 2015.
MISS CARABELLE
MCLE Compliance No. V-00000/ March 9, 2016
WITNESSES:
1. Mickey Mouse, San Felipe Street, Valley 2, Nueva York City;
2. The Manager or any of his/her duly authorized representative, LDR Long Distance Bank,
Makati Branch, Upper Ground Floor, 7912 Olympia Towers Makati Ave cor. Sto.
Tomas St., Makati City- duces tecum – to bring with him/her the pertinent records
relative to Checking Account No. 0YYYY more particularly the reason why LDR
Makati branch, Check No. 00XXX dated March 12, 2014 in the amount of
Php400,000.00, was dishonored upon presentment for payment.
And OTHERS.
Address of Accused: Somewhere Nowhere Bldg., West End, Nueva York City
- at large –
APPROVED:
DAISY DUCK
City Prosecutor
MCLE Compliance No. V-0010000 March 15, 2016
Roll of Attorneys No. 4-AAAA
SAMPLE FORM NO. 5. HOMICIDE

REGIONAL TRIAL COURT
Branch
Nueva York City
THE PEOPLE
OF THE PHILIPPINES,
- versus - for
JIM CROW, HOMICIDE

Accused.
x---------------------------------x
INFORMATION
The undersigned Assistant City Prosecutor hereby accuses JIM CROW for the crime
of Homicide, defined and penalized under the provisions of Article 249 of the Revised Penal
Code, committed as follows:
That on or about April 1, 2001, at around 11:00 in the morning at Brgy. Liliput,
Nueva York City, Philippines and within the jurisdiction of this Honorable Court, the above-
named accused, together with one individual whose identity has not yet been fully
established, while armed with a short firearm of unknown caliber, a deadly weapon, with
intent to kill and without any justifiable cause, did then and there willfully, unlawfully and
feloniously attack, assault, and shoot several times with said firearm one Jack Ripper thereby
hitting him and causing him “multiple gunshot wounds”, which directly caused his death.
CONTRARY TO LAW.
Nueva York City, September 14, 2020.
BRENDA STARR
MCLE Compliance No. VI-XXXX2/May 1, 2016
Roll of Attorneys No. 6xxx
CERTIFICATION
charged was committed and there is a reasonable ground to believe that accused herein is
It is further certified that a notice of complaint was sent to the accused at his known
address, together with the evidence against him and he was given the opportunity to submit
controverting evidence.
BRENDA STARR
SUBSCRIBED AND SWORN to before me this 14 day of September, 2020 at
Batangas City.
NANCY DREW
MCLE Compliance No. VI-XXXX / March 2, 2016
WITNESSES:
Nancy Page, Brgy. Hill, Nueva York City;

SPO1 Barney Friend, Officer on Case, PNP, NYCPS, Nueva York City;
Dr. Stephen Common, Startlab Hospital, Nueva York City
And OTHERS.
Address of Accused: Brgy. Liliput, Nueva York City – at large –
BAIL RECOMMENDED : Php120,000.00
APPROVED:
SHERLOCK HOLMES
City Prosecutor
MCLE Compliance No. VI-XXXX/April 2, 2016
SAMPLE FORM NO. 6. MURDER

REGIONAL TRIAL COURT
Branch
Bulwagan ng Katarungan
Nueva York City
THE PEOPLE
OF THE PHILIPPINES,
- versus - for
JACK D. RIPPER, MURDER

,
Accused.
x---------------------------------x
INFORMATION
The undersigned Assistant City Prosecutor hereby accuses JACK D. RIPPER of the
crime of Murder, defined and penalized under the provisions of Article 248 of the Revised
Penal Code, committed as follows:
That on or about June 12, 2000 at around 2:00 in the afternoon at Brgy. Liliput,
Nueva York City, Philippines and within the jurisdiction of this Honorable Court, the above-
named accused, while armed with a firearm of unknown caliber, a deadly weapon, with
intent to kill, without any justifiable cause, and with the qualifying circumstance of treachery,
did then and there willfully, unlawfully and feloniously attack, assault and shoot one JIM
CROW with said firearm, while said JIM CROW was unarmed and completely defenseless,
thereby causing “gunshot wound” on his chest, which directly caused his death.
That the special aggravating circumstance of the use of unlicensed firearm is

attendant in the commission of the offense.
CONTRARY TO LAW.
Nueva York City, August 12, 2000
BRENDA STARR
CERTIFICATION
BRENDA STARR
SUBSCRIBED AND SWORN to before me this 10 thday of August 2000 at Nueva

York City.
NANCY DREW
WITNESSES:
1. Nancy Page, Brgy. Hill, Nueva York City;

2. SPO1 Barney Friend, Officer on Case, PNP, NYCPS, Nueva York City;
3. Dr. Stephen Common, Startlab Hospital, Nueva York City
And OTHERS.
Address of Accused: Brgy. Liliput, Nueva York – at large –
NO BAIL RECOMMENDED
APPROVED:
SHERLOCK HOLMES
City Prosecutor
SAMPLE FORM NO. 7. THEFT

Branch
Bulwagan ng Katarungan
Nueva York City
THE PEOPLE
OF THE PHILIPPINES,
- versus - for
LUPEIN TENADIER THEFT

Accused.
x---------------------------------x
INFORMATION
The undersigned Associate City Prosecutor hereby accuses Lupien Tenadier for the
crime of Theft, defined and penalized under the provisions of Article 308 in relation to
Article 309, par. 3, of the Revised Penal Code as amended by Republic Act No. 10951,
committed as follows:
That on or about June 11, 2010 at around 11:45 in the morning at Parisian St. Nueva
York City, Philippines, and within the jurisdiction of this Honorable Court, the above-named
accused, with intent to gain and without the knowledge and consent of the owner thereof, did
then and there willfully, unlawfully and feloniously take, steal and carry away cash money
amounting to SIXTY THOUSAND PESOS (Php60,000.00), Philippine Currency belonging
to Dona Lafitte, to the damage and prejudice of the said owner in the aforementioned amount
of Php60,000.00, Philippine Currency.
CONTRARY TO LAW.
Nueva York City, July 10, 2010.
MARIUS MONTMERCY
CERTIFICATION
MARIUS MONTMERCY
SUBSCRIBED AND SWORN to before me this 10th day of July, 2010 at Nueva
York City.
GUISSANT ELJORAS
WITNESSES:
4. Dona Lafitte, Parisian St., Nueva York City;

5. SPO1 Lucy Manette, Officer on Case, PNP, NYCPS, Nueva York City;
And OTHERS.
Address of Accused: Brgy. Liliput,, Batangas City – at large –
BAIL RECOMMENDED : Php30,000.00
APPROVED:
SHERLOCK HOLMES
City Prosecutor
SAMPLE FORM NO. 8

Branch
Nueva York City
THE PEOPLE
OF THE PHILIPPINES,
- versus - for
SALINE TENADIER, ESTAFA

Accused.
x-----------------------------------------x
INFORMATION
The undersigned Assistant City Prosecutor hereby accuses Saline Tenadier of the
crime of Estafa defined and penalized under the provisions of Article 315, par. 2(a) of the
Revised Penal Code, as amended by R.A. 10951 committed as follows:
That on or about January 12, 2015 at Nueva York City, Philippines and within the
jurisdiction of this Honorable Court, the above-named accused, through false pretenses and
fraudulent acts, that is, by falsely pretending to possess business or imaginary transaction or
by means of other similar deceits executed prior to or simultaneously with the commission of
the fraud which was relied upon by Pantine Beauvior, did then and there willfully, unlawfully
and feloniously defraud said Pantine Beauvior, in the following manner:
Said accused, with intent to defraud, by means of false manifestations and fraudulent
representations which she foisted on the person of Pantine Beauvior, did then and there
willfully, unlawfully, feloniously represent to the latter that she (accused) has a rice business
for which she needed additional funds/money for capital investment and that she has the
capacity to make a return of said investment and its corresponding profit, which
representations induced and convinced said Pantine Beauvior to give and deliver to accused
the amount of THREE HUNDRED THOUSAND PESOS(Php300,000.00), Philippine
Currency; when in truth and in fact, the representations made by said accused were
absolutely false and fraudulent and were made only to obtain, as in fact, accused obtained
from Jeriel Padilla y Ramirez the amount of Php300,000.00, Philippine Currency; and worse,
upon verification made by said Pantine Beauvior, he discovered that the investment for
which accused asked for money with capital return and profit are all lies; and despite
demands to return the said amount, accused failed and refused to do so, to the damage and
prejudice of said Pantine Beauvior in the said amount of TWO HUNDRED THOUSAND
PESOS(Php300,000.00), Philippine Currency.
CONTRARY TO LAW.
Nueva York, June 11, 2015.
MARIUS MONTMERCY
CERTIFICATION
MARIUS MONTMERCY
SUBSCRIBED AND SWORN to before me this 10 th day of July, 2010 at Nueva

York City.
GUISSANT ELJORAS
WITNESSES:
1. Pantine Beauvoir, Parisian St., Nueva York City

2. Sis Agnes Dela Fray, Parisian St., Nueva York City.
And OTHERS.
Address of Accused: Brgy. West End, Nueva York City - at large -
APPROVED:
SHERLOCK HOLMES
City Prosecutor
FORM NO. 9. COMPLAINT-AFFIDAVIT (ENGLISH)
REPUBLIC OF THE PHILIPPINES)
CITY OF NUEVA YORK ) S.S.
COMPLAINT-AFFIDAVIT
I, MINIE MICE, of legal age, married, Filipino and a resident of Terra Nova Subd.,
Nueva York City, after having been duly sworn to according to law hereby depose and state:
1. Sometime in April 2015, Spouses Donald and Daisy Quack offered to sell to
me and my husband Mickey Mice a parcel of land classified as agricultural with an area of
Five Thousand (5,000) square meters located at Crossroad, Nueva York City, in the amount
of Three Hundred Pesos (Php 500.00) per square meter covered and embraced in the
Owner’s Duplicate Copy of Katibayan ng Orihinal Na Titulo Blg.P-00001 of the Registry of
Deeds for the Provice of Laguna.
2. At that time, I and my husband were considering to engage in agricultural

business so the idea of buying the aforesaid land crossed our minds.
3. On August 1, 2015, Spouses Donald and Daisy Quack gave us the title to the
said parcel of land consisting of two (2) pages. The same appeared to be original and
authentic. Copy of the Katibayan ng Orihinal Na Titulo Blg.P-00001 is hereto attached as
Annex A and made an integral part hereof.
4. Since no encumbrances are annotated on the said title, we decided to buy the
said property.
5. We have executed a Deed of Absolute Sale over the said parcel of land in the
amount of Two Million Five Hundred Thousand Pesos (Php 2, 500, 000.00) which was
signed by the respondents. Copy of the Deed of Absolute Title and the Acknowledgment
Receipt are hereto attached as Annexes B and C and made integral part hereof.
6. On October 2, 2015, we started the process of transferring the title over the
said property to us. Accordingly, we secured a certified copy of the Katibayan ng Orihinal
Na Titulo Blg.P-00001 before the Registry of Deeds of the Province of Laguna, Copy of the
Certified Copy of the Katibayan ng Orihinal Na Titulo Blg.P-00001 is hereto attached as
Annex D and made integral part hereof.
7. We were shocked when we discovered that the Owner’s Duplicate Copy of

the Katibayan ng Orihinal Na Titulo Blg.P-00001 given to us by Spouses Quack is fake and
falsified. As per examination, the certified true copy secured from the Registry of Deeds for
the Province of Laguna appeared to consist of Five (5) pages with some encumbrances
showing that the property had been mortgaged several times while the owner’s duplicate
copy which the Spouses Quack gave us merely consists of two (2) pages without any
annotation therein whatsoever.
8. After we found out that the title given to us was fake, we informed them about
our discovery and asked for the return of our money but they refused to do so.
9. Considering the obstinate refusal of Daisy and Donald Quack to return our
money, we secured the services of a counsel who sent them a letter of demand. Copy of the
letter of Demand is hereto attached as Annex E and made integral part hereof.
10. However, Spouse Quack suddenly left their residential house after receiving
the letter of demand and until now, their whereabouts remain unknown.
11. I am executing this sworn statement to attest to the truth of the foregoing
matters and serve as basis for the criminal complaint for Estafa thru Falsification of Public
Document under Article 315 of the Revised Penal Code in relation to Articles 171 and 48 of
the Revised Penal Code against Spouses Daisy and Donald Quack of No. 18. Burrow St.
Nueva York City.
IN WITNESS WHEREOF, I have here unto affixed my signature this day of

at the City of Nueva York.
MINIE MICE
Affiant
SUBSCRIBED AND SWORN TO before me this day of at

Nueva York City. I hereby certify that I have personally examined the above-named affiant
and that I am satisfied that the foregoing statements were given by her voluntarily and of her
own free will.
ADMINISTERING OFFICER
FORM NO. 10. SAMPLE COMPLAINT-AFFIDAVIT (FILIPINO)
REPUBLIKA NG PILIPINAS )
LUNGSOD NG NUEVA YORK ) S.S.
SINUMPAANG SALAYSAY
AKO, si JUAN MAGULO, may asawa, sapat ang gulang, Filipino at nakatira sa
Purok 2, Upper Hill, Nueva York City, matapos makapanumpa nang naaayon sa batas ay
nagsalaysay:
1. Kasal ako kay Petra Mabiro noong ika-28 ng Mayo, 2010, sa Holy Trinity
Parish, San Fernando City. Kalakip nito ang aming Certificate of Marriage bilang Annex “A”
2. Sa aming pagsasama ay nagkaroon kami ng dalawang anak anak na

nagngangalang Pedrito (12 years old) at Juanita (8 years old). Kalakip dito ang Certificates of
Birth nila bilang Annexes “B” at “C”.
3. Noong una ay maayos naman ang aming pagsasama at hindi naman kami
nagkakaroon ng malaking mga suliranin pangmag-asawa.
4. Subalit makalipas ang halos isang taon lang ang nakakalipas ay hindi na
naging maayos ang aming pag-aasawa dahil palagi na kaming nag-aaway simula noong ma-
discover ko na may picture siya sa Friendster na may ka-holding hands na ibang lalaki.
5. Sa kabila nito ay tiniis ko ang sitwasyon dahil umaasa ako na maayos din
namin ang aming mga problema pagkalipas ng ilang panahon.
6. Sa loob ng mga 2 hanggang 3 taon ay nakatira pa kami sa aking mga

magulang at matapos ito ay lumipat kami sa Manila dahil doon ay nagtrabaho kami.
7. Matapos ang walong taon ay umuwi na kami sa Nueva York City at nakitira
sa bahay ng kanyang mga magulang sa Brgy. West Side, Nueva York City.
8. Noong April 20, 2020 ay nag-away kami dahil matapos niyang maligo ay
nagvideo call agad siya sa boyfriend niya. Dahil dito ay umuwi na ulit ako sa bahay ng mga
magulang ko.
9. Kinabukasan ay nagmessage siya na ayusin na raw namin kaya noong April

22, matapos ang aking trabaho, ay umuwi ako sa bahay ng magulang niya. Ilanga raw
kaming hindi nag-away.
10. Subalit noong ikalawang linggo ng Mayo 2020 ay hiniram ko ang cellphone
niya para manood sana ng Netflix. Laking gulat ko nang mabuksan ko ang fb messenger niya
ay nakita ko ang 3 pictures ng boyfriend niya na magkasama sila sa kama, na dalawa ay wala
silang damit pareho, Nakalakip dito ay ang kopya ng nasabing mga larawan bilang Annexes
“D” hanggang “F”.
11. Kinunpronta ko siya tungkol doon at sinabi niya sa akin na boyfriend niya
yung lalaki.
12. Noong itinanong ko kung ano ang ginagawa nila na magkasama na walang
damit ay sinagot niya ako na “e di may nangyari sa amin, ibinigay ko na lahat.”
13. Tinanong ko siya kung kailan nangyari iyon at sinabi niya na nagcelebrate
daw sila ng birthday niya noong Marso 11, 2020 sa bahay ng lalaki sa Villa Ville, Nueva
York City.
14. Noong sinabi ko sa kanyang ang sama-sama ng ugali niya ay sinagot niya ako
na wala akong magagawa at kahit makulong siya ay sasama pa siyang magdemanda ako.
Dahil sa sinabi niya ay ipinadala ko sa messenger ang mga pictures sa fb messenger ko
habang kaharap ko siya. Matapos iyon ay kinuha niya na ulit ang cellphone niya sa akin.
15. Matapos yun ay hinahanap ko ang facebook profile noong lalaki na

nagngangalang Andres de Luco at kinunpronta ko siya sa relasyon nila ng aking asawa.
16. Ang sabi niya sa akin ay sa pagkakaintindi niya sa pag-uusap nila ng asawa ko
ay talagang wala na kami at hiwalay na kami.
17. Na malinaw sa deklarasyon ng aking asawa at sa mga pictures nila ng kabit

niya na sila ay nagtalik noong Marso 11, 2020 sa bahay nung lalaki.
18. Dahil dito ay ipinasya ko na magsampa ng kaso sa ginawa nilang kataksilan

laban sa akin.
19. ISINAGAWA ko ang Sinumpaang Salaysay na ito upang patunayan ang mga
nabanggit na pangyayari at upang maging basehan ng hablang Adultery, sang-ayon sa Article
333 ng Revised Penal Code, laban sa aking asawa na si Petra Mabiro-Malabo na nakatira sa
Purok 1, West Side, Nueva York City, at Andres de Luco, na nakatira sa Villa Ville, Nueva
York City.
BILANG PATUNAY ay inilagda ko ang aking pangalan ngayong ng Hulyo

2020 sa Lungsod ng Nueva York .
JUAN MAGULO
Nagsalaysay
SUBSCRIBED AND SWORN to before me this day of July 2020. I further

certify that I have personally examined the affiant and I am satisfied that he voluntarily
executed and understood his affidavit.
ADMINISTERING OFFICER

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Jurists Bar Review Center™: Sample Forms For Criminal Law Practical Exercises

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JURISTS BAR REVIEW CENTER™

SAMPLE FORMS FOR CRIMINAL LAW

Republic of the Philippines

KAREN MARITES, ORAL DEFAMATION

Nueva York, August 1, 2018

This is to certify that as represented, the provisions of Chapter 7, Section 412 of

SUBSCRIBED AND SWORN to before me this 9th day of November, 2020 at

Jessica Jones, Angle Subd., Brgy. Flora, Nueva York City;

Address of Accused: Brgy. Starlight, Nueva York City – at large –

BAIL UNNECESSARY UNLESS REQUIRED BY THE COURT:

Republic of the Philippines

RUDOLP RANDEER, RECKLESS IMPRUDENCE

Province of Batangas, March 30, 2010.

SP02 Nicholas Claus

SP01 Glimi Elfe

BAIL RECOMMENDED: Php17,000.00

Republic of the Philippines

JULIAN MAINITIN , RECKLESS IMPRUDENCE RESULTING

Nueva York City, October 3, 2018.

1. Kapitani Hook, Brgy. Copper Plain, Nueva York City;

4. Dr. Wyatt Earp, Wild West Hospital, Nueva York City

Address of Accused: Brgy. Copper Plain, Nueva York City - at large –

BAIL RECOMMENDED: Php10,000.00

Republic of the Philippines

DONALD DUCK, VIOLATION OF B.P. BLG. 22

Nueva York City, April 16, 2015.

BAIL RECOMMENDED: Php66,000.00

Republic of the Philippines

JIM CROW, HOMICIDE

Nueva York City, September 14, 2020.

Nancy Page, Brgy. Hill, Nueva York City;

Address of Accused: Brgy. Liliput, Nueva York City – at large –

BAIL RECOMMENDED : Php120,000.00

Republic of the Philippines

JACK D. RIPPER, MURDER

That the special aggravating circumstance of the use of unlicensed firearm is

Nueva York City, August 12, 2000

SUBSCRIBED AND SWORN to before me this 10 thday of August 2000 at Nueva

1. Nancy Page, Brgy. Hill, Nueva York City;

Address of Accused: Brgy. Liliput, Nueva York – at large –

Republic of the Philippines

LUPEIN TENADIER THEFT

Nueva York City, July 10, 2010.

4. Dona Lafitte, Parisian St., Nueva York City;

Address of Accused: Brgy. Liliput,, Batangas City – at large –

BAIL RECOMMENDED : Php30,000.00

Republic of the Philippines

SALINE TENADIER, ESTAFA

Nueva York, June 11, 2015.

SUBSCRIBED AND SWORN to before me this 10 th day of July, 2010 at Nueva

1. Pantine Beauvoir, Parisian St., Nueva York City

Address of Accused: Brgy. West End, Nueva York City - at large -

BAIL RECOMMENDED: Php18,000.00

FORM NO. 9. COMPLAINT-AFFIDAVIT (ENGLISH)

2. At that time, I and my husband were considering to engage in agricultural

7. We were shocked when we discovered that the Owner’s Duplicate Copy of

IN WITNESS WHEREOF, I have here unto affixed my signature this day of

SUBSCRIBED AND SWORN TO before me this day of at

2. Sa aming pagsasama ay nagkaroon kami ng dalawang anak anak na

6. Sa loob ng mga 2 hanggang 3 taon ay nakatira pa kami sa aking mga

9. Kinabukasan ay nagmessage siya na ayusin na raw namin kaya noong April

15. Matapos yun ay hinahanap ko ang facebook profile noong lalaki na

17. Na malinaw sa deklarasyon ng aking asawa at sa mga pictures nila ng kabit