NPS Investigation Form No. 01, s.
2008 FOR REGULAR PRELIMINARY INVESTIGATION
REPUBLIC OF THE PHILIPPINES
DEPARTMENT OF JUSTICE
NATIONAL PROSECUTUION OFFICE
PROVINCIAL PROSECUTION OFFICE
LUCENA CITY, QUEZON
INVESTIGATION DATA FORM
To be accomplished by the Office
DATE RECEIVED: NPS DOCKET NO.__ IV-09-INV-15F-00298____
(Stamped and initiated): ______________________________ Assigned to _______________________________________________
Time Received:__________________________________________ Date Assigned ____________________________________________
To be accomplished by complainant/s’ counsel/law enforcer
(Use back portion if space is not sufficient)
COMPLAINANT/S RESPONDENT/S
(Name [First/M/Last Name] Sex, Age, Address) (Name [First/M/Last Name] Sex, Age, Address)
_BENITO LUNAR and RONALD NEVERA________________ __ANACLETO OBLEA LADINES ______________
_Brgy. Nagsinamo ____________ __Lopez Jaena Street, Lucban ___________________
_Lucban, Quezon ___ __Quezon________________________________________________
__ _________________ ____________________________________________________________
_ ___ __MICHAEL LADINES____ ___________________
_____ __Lopez Jaena st., Lucban, Quezon ______________
LAWS VIOLATED WITNESSES (Name and Address)
__ESTAFA _______________________________ __ALFREDO LACO __
__Under Article 315, par. 2(a), R.P.C.__________ ________ __G. Del Pilar Street, Lucban ________________
_______________________________________________________________ _ Quezon; __
_______________________________________________________________ __Others _______
DATEs AND TIMEs OF COMMISSION: PLACE/s OF COMMISSION:
May 27 and 29, 2015___ ___ _ ___Lucban, Quezon _________________________________
_______________________________________________________________ ____________________________________________________________
_______________________________________________________________ ____________________________________________________________
1. Has a similar complaint been filed before any other office? Yes ________ No__✔____
2. Is the complaint in the nature of a counter-affidavit? Yes ___✔____ No________
If yes, indicate details below.
3. Is this complaint related to another case before this office? Yes ___✔____ No________
If yes, indicate details below.
I.S. No. ___IV-09-INV-15F-00298 ____
Offenses ______________________________ ______________
Handling Prosecutor__________________ __________________________
CERTIFICATION
WE CERTIFY, under oath, that all the information on this sheet are true and correct to the best of our
knowledge and belief; that we have not commenced any action or filed any claim involving the same issue in any court,
tribunal or quasi-judicial agency; and if we should thereafter learn that similar action has been filed and/or is pending,
we shall report that fact to this Honorable Office within five (5) days from knowledge thereof.
_____________RONALD NEVERA__________ _____________BENITO LUNAR_________
(Signature over Printed Name) (Signature over Printed Name)
SUBSCRIBED AND SWORN TO before me this ___________ day of ___________________________ in__________________________.
_____________________________________________________
Assistant Provincial Prosecutor
