Republic of the PhilippinesProvince of Nueva Ecija

BARANGAY SAN RAFAEL

OFFICE OF THE BARANGAY CHAIRMAN

________________________________ COMPLAINANTMACARSE, ZARAGOZA, NUEVA ECIJA

----VERSUS---- BARANGAY CASE No: ___________ FOR: ________________________

________________________________ ACCUSEDSAN RAFAEL, ZARAGOZA, NUEVA ECIJA

TO WHOM IT MAY CONCERN;

This is to certify that the above name parties underwent mediation process before this Barangay but the same failed.

Hence, the same maybe now filed before the appropriate court.This certification is issued for any legal intent it may served.Issued this ____ day of _________________.

ATTESTED:

MAGILIW GABRIEL Secretary

HON. PERFECTO A. GALMAN Barangay Chairman