ITEM “C” – VICTIM DATA

 CHECK HERE IF THE REPORTING PERSON (ITEM “A”) IS THE VICTIM. PROCEED TO ITEM “D”.
 CHECK HERE IF THERE ARE TWO OR MORE VICTIMS. USE ADDITIONAL INCIDENT REPORT FORM SHEETS FOR THE DATA OF THE ADDITIONAL VICTIMS.
FAMILY NAME N//A FIRST NAME N/A MIDDLE NAME N/A QUALIFIER NICKNAME N/A
N/A

CITIZENSHIP SEX/GENDER CIVIL STATUS DATE OF BIRTH (DD/MM/YY) AGE PLACE OF BIRTH N/A HOME PHONE MOBILE PHONE
N/A N/A N/A N/A N/A N/A N/A

CURRENT ADDRESS (HOUSE NUMBER/STREET) VILLAGE/SITIO BARANGAY TOWN/CITY PROVINCE

N/A N/A N/A N/A N/A

OTHER ADDRESS (HOUSE NUMBER/STREET) VILLAGE/SITIO BARANGAY TOWN/CITY PROVINCE

N/A N/A N/A N/A N/A

HIGHEST EDUCATIONAL ATTAINMENT OCCUPATION WORK ADDRESS EMAIL ADDRESS (If Any)
N/A N/A N/A N/A

ITEM “D” - NARRATIVE OF INCIDENT

BLOTTER ENTRY NUMBER TYPE OF INCIDENT TIME DATE PLACE OF INCIDENT

ENTER IN DETAIL THE NARRATIVE OF THE INCIDENT OR EVENT, ANSWERING THE WHO, WHAT, WHEN, WHERE, WHY AND HOW OF REPORTING. (USE ADDITIONAL SHEET/S IF NECESSARY)

On the afternoon of June 5, 2023, my classmates and I were engaged in surveillance for our final project in
Criminal Law Book II. Between 3:00 and 4:00, we took a break to take a group photo. During the photo, we observed two
individuals on a motorcycle with the license plate 897DED. The driver was wearing a printed long sleeve shirt and a red
helmet, while the passenger had a red shirt and a black cap.Later, when we visited CloudMeets near the 7-Eleven to buy
drinks, we encountered the same two men again. However, this time the man in the red shirt was driving a different
motorcycle with the license plate 524NDY and wearing a black helmet, while the other man continued to ride the previous
motorcycle. Our suspicion grew when these individuals halted and stared at us. It is worth noting that prior to this incident,
Atty. Lance Dador openly revealed that he has been receiving death threats.

(DETAILS OF THIS NARRATIVE SHALL BE THE BASIS IN THE ENTRY OF RECORD IN THE POLICE BLOTTER)

AUTHENTICATION
I HEREBY CERTIFY TO THE CORRECTNESS OF THE NAME/SIGNATURE OF REPORTING PERSON NAME/SIGNATURE OF DESK OFFICER
FOREGOING TO THE BEST OF MY KNOWLEDGE AND
BELIEF.

CASE DISPOSITION (For Chief/Head of Office Use Only)

CHIEF Of STATION/OFFICE INSTRUCTIONS NAME OF DESIGNATED INVESTIGATOR-ON-CASE NAME OF CHIEF OF STATION/OFFICE

-----------------------------CUT HERE--------------------------------------------------------------------------------------CUT HERE------------------------------------------------------

INSTRUCTIONS TO REPORTING PERSON
Keep this Incident Record Transaction Receipt (IRTR). An update of the progress of the investigation of the crime or incident that you reported
will be given to you upon presentation of this IRTR. For your reference, the data below is the contact details of this police station.

Name of Police Station Telephone

Investigator-on-Case Mobile Phone

Name of Chief/Head of
Mobile Phone
Office
 ITEM “C” – VICTIM DATA
 CHECK HERE IF THE REPORTING PERSON (ITEM “A”) IS THE VICTIM. PROCEED TO ITEM “D”.
 CHECK HERE IF THERE ARE TWO OR MORE VICTIMS. USE ADDITIONAL INCIDENT REPORT FORM SHEETS FOR THE DATA OF THE ADDITIONAL VICTIMS.
FAMILY NAME N//A FIRST NAME N/A MIDDLE NAME N/A QUALIFIER NICKNAME N/A
N/A

CITIZENSHIP SEX/GENDER CIVIL STATUS DATE OF BIRTH (DD/MM/YY) AGE PLACE OF BIRTH N/A HOME PHONE MOBILE PHONE
N/A N/A N/A N/A N/A N/A N/A

CURRENT ADDRESS (HOUSE NUMBER/STREET) VILLAGE/SITIO BARANGAY TOWN/CITY PROVINCE

N/A N/A N/A N/A N/A

OTHER ADDRESS (HOUSE NUMBER/STREET) VILLAGE/SITIO BARANGAY TOWN/CITY PROVINCE

N/A N/A N/A N/A N/A

HIGHEST EDUCATIONAL ATTAINMENT OCCUPATION WORK ADDRESS EMAIL ADDRESS (If Any)
N/A N/A N/A N/A

ITEM “D” - NARRATIVE OF INCIDENT

BLOTTER ENTRY NUMBER TYPE OF INCIDENT TIME DATE PLACE OF INCIDENT

ENTER IN DETAIL THE NARRATIVE OF THE INCIDENT OR EVENT, ANSWERING THE WHO, WHAT, WHEN, WHERE, WHY AND HOW OF REPORTING. (USE ADDITIONAL SHEET/S IF NECESSARY)

On June 5, 2023, my classmates and I were doing surveillance for our Criminal Law project. During a group photo,
we noticed two men on a motorcycle with license plate 897DED. The driver wore a printed long sleeve shirt and a red
helmet, while the passenger had a red shirt and a black cap. Later, at CloudMeets near the 7-Eleven, we saw the same two
men again. This time, the man in the red shirt was driving a different motorcycle with license plate 524NDY, and the other
man was still with him on the same motorcycle. We became suspicious when they stopped and stared at us. Before this, our
teacher, Atty. Lance Dador, had mentioned receiving death threats and stated, "I eat death threats as breakfast" during class.

(DETAILS OF THIS NARRATIVE SHALL BE THE BASIS IN THE ENTRY OF RECORD IN THE POLICE BLOTTER)

AUTHENTICATION
I HEREBY CERTIFY TO THE CORRECTNESS OF THE NAME/SIGNATURE OF REPORTING PERSON NAME/SIGNATURE OF DESK OFFICER
FOREGOING TO THE BEST OF MY KNOWLEDGE AND
BELIEF.

CASE DISPOSITION (For Chief/Head of Office Use Only)

CHIEF Of STATION/OFFICE INSTRUCTIONS NAME OF DESIGNATED INVESTIGATOR-ON-CASE NAME OF CHIEF OF STATION/OFFICE

-----------------------------CUT HERE--------------------------------------------------------------------------------------CUT HERE------------------------------------------------------

INSTRUCTIONS TO REPORTING PERSON
Keep this Incident Record Transaction Receipt (IRTR). An update of the progress of the investigation of the crime or incident that you reported
will be given to you upon presentation of this IRTR. For your reference, the data below is the contact details of this police station.

Name of Police Station Telephone

Investigator-on-Case Mobile Phone

Name of Chief/Head of
Mobile Phone
Office
 ITEM “C” – VICTIM DATA
 CHECK HERE IF THE REPORTING PERSON (ITEM “A”) IS THE VICTIM. PROCEED TO ITEM “D”.
 CHECK HERE IF THERE ARE TWO OR MORE VICTIMS. USE ADDITIONAL INCIDENT REPORT FORM SHEETS FOR THE DATA OF THE ADDITIONAL VICTIMS.
FAMILY NAME N//A FIRST NAME N/A MIDDLE NAME N/A QUALIFIER NICKNAME N/A
N/A

CITIZENSHIP SEX/GENDER CIVIL STATUS DATE OF BIRTH (DD/MM/YY) AGE PLACE OF BIRTH N/A HOME PHONE MOBILE PHONE
N/A N/A N/A N/A N/A N/A N/A

CURRENT ADDRESS (HOUSE NUMBER/STREET) VILLAGE/SITIO BARANGAY TOWN/CITY PROVINCE

N/A N/A N/A N/A N/A

OTHER ADDRESS (HOUSE NUMBER/STREET) VILLAGE/SITIO BARANGAY TOWN/CITY PROVINCE

N/A N/A N/A N/A N/A

HIGHEST EDUCATIONAL ATTAINMENT OCCUPATION WORK ADDRESS EMAIL ADDRESS (If Any)
N/A N/A N/A N/A

ITEM “D” - NARRATIVE OF INCIDENT

BLOTTER ENTRY NUMBER TYPE OF INCIDENT TIME DATE PLACE OF INCIDENT

ENTER IN DETAIL THE NARRATIVE OF THE INCIDENT OR EVENT, ANSWERING THE WHO, WHAT, WHEN, WHERE, WHY AND HOW OF REPORTING. (USE ADDITIONAL SHEET/S IF NECESSARY)

On June 5, 2023, while conducting surveillance for our final project in Criminal Law Book II, my classmates and I took
a break for a group photo. During the photo, we noticed two men on a motorcycle with the license plate 897DED. The driver
wore a printed long sleeve shirt and a red helmet, while the passenger had a red shirt and a black cap. Later, we saw the
same two men again while buying drinks at CloudMeets near the 7-Eleven. This time, the man in the red shirt was driving a
different motorcycle with the license plate 524NDY and wearing a black helmet, while the other man continued riding the
same motorcycle. We became suspicious when the two men stopped and stared at us. It's worth mentioning that prior to
this, Atty. Lance Dador had mentioned receiving death threats, and he would sometimes say, "I eat death threats as
breakfast" during our class hour.

(DETAILS OF THIS NARRATIVE SHALL BE THE BASIS IN THE ENTRY OF RECORD IN THE POLICE BLOTTER)

AUTHENTICATION
I HEREBY CERTIFY TO THE CORRECTNESS OF THE NAME/SIGNATURE OF REPORTING PERSON NAME/SIGNATURE OF DESK OFFICER
FOREGOING TO THE BEST OF MY KNOWLEDGE AND
BELIEF.

CASE DISPOSITION (For Chief/Head of Office Use Only)

CHIEF Of STATION/OFFICE INSTRUCTIONS NAME OF DESIGNATED INVESTIGATOR-ON-CASE NAME OF CHIEF OF STATION/OFFICE

-----------------------------CUT HERE--------------------------------------------------------------------------------------CUT HERE------------------------------------------------------

INSTRUCTIONS TO REPORTING PERSON
Keep this Incident Record Transaction Receipt (IRTR). An update of the progress of the investigation of the crime or incident that you reported
will be given to you upon presentation of this IRTR. For your reference, the data below is the contact details of this police station.

Name of Police Station Telephone

Investigator-on-Case Mobile Phone

Name of Chief/Head of
Mobile Phone
Office