POLICE BLOTTER

I, BLACK J. PARLADE, of legal age, single, Filipino, with

address at 808, 15th St. Pangpang, Sorsogon City, after having been
sworn in accordance with law, do hereby depose and say:

1. That, I am filing a criminal complaint for ANTI CARNAPPING

ACT OF 1972 (R.A. 6539) against BEN J. LAGIM, of legal age,
Filipino, and a resident of 021 8th St, Pangpang Sorsogon City.

2. That, on January 03, 2023, tricycle with Plate Number TS -

9952, Engine Number KR 20004X00916E, Chasis Number KR 200-
04Y-009126, was stolen by the respondents while parked outside my
house at Brgy. 808, 15th St. Pangpang, Sorsogon. Evidence of my
ownership thereto is a Chattle Mortgage and is herewith attached as
Annex “A”. The Certificate of Registration and Official Receipt issued
by the Land Transportation Office are likewise attached in this
complaint-affidavit and are respectively marked as Annex “B” and
Annex “C”;

3. That, this incident was reported at Pangpang Station. A copy

of the police blotter is attached as Annex “D”;

8. That, the police officers further inquired from him if who are
the persons responsible for carnapping the tricycle, he mentioned the
name of Ben Lagim, the respondent;

9. That, the act of respondent in stealing the tricycle was with

intent to gain and the taking is without consent of the owner

10. That, I execute this complaint-affidavit to attest to the

truthfulness of the foregoing facts.

1
 IN WITNESS WHEREOF, I have hereunto affixed my signature
this November 21, 2022 Sorsogon City, Philippines.

BLACK J. PARLADE
Affiant
Postal I.D. No 5181083
Valid Until 07/05/25

SUBSCRIBED AND SWORN to before me, this November 21,

2023 at Sorsogon City, Philippines. (CERTIFICATION- I hereby certify
that I have personally examined the affiant and that I am fully satisfied
that he voluntarily executed and understood his complaint affidavit).

Doc. No. ________;

Page No. _______;
Book No. _______ ;
Series of 2023.