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REPUBLIC OF THE PHILIPPINES

PROVINCE OF AGUSAN DEL NORTE


MUNICIPALITY OF NASIPIT
BARANGAY CULIT

OFFICE OF THE LUPONG TAGAPAMAYAPA

___________________________ Barangay Case No. _____________


___________________________ FOR: _______________________
Complainant/s

- Against -

___________________________
___________________________
Respondent/s

COMPLAINT

I/We hereby complain against the above named respondent/s for violating my/our rights and
interests in the following manner:

Therefore, I/We pray that the following relief/s be granted to me/us in accordance with the law
and/or equity:

Made this ____ day of ___________, 2023.

__________________________`
Complainant/s

Received and filed this _____ day of ________________, 2023.

HON. JOEL A. PEPITO


Punong Barangay / Lupon Chairman

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