OFFICE OF THE LUPON TAGAPAMAYAPA

Barangay Case No. ____-2023

___________________________ For: PHYSICAL INJURY
Complainant

-against-

___________________________ Received:
________________________________
Respondent

SUMMONS
You are hereby summoned to appear before me in person, together with your witness, on the
03RD day of MAY, 2023 (WEDNESDAY) at 02:00 o’clock in the afternoon, then and there to
answer to a complaint made before me for mediation / conciliation of your dispute with
complainant.

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.

FAIL NOT or else face punishment for contempt of court.

02 May 2023,

________________________________
Punong Barangay/ Lupon Chairman