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KATARUNGANG PAMBARANGAY

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KP FORM # 23: CERTIFICATION TO BAR ACTION<br />

Republic of the Philippines<br />

Province of __________<br />

CITY/MUNICIPALITY OF ______________<br />

Barangay _________________<br />

OFFICE OF THE LUPONG TAGAPAMAYAPA<br />

___________________ Barangay Case No. __________<br />

___________________ For: ______________________<br />

Complainant/s _________________________<br />

__________________________<br />

— against —<br />

__________________<br />

__________________<br />

Respondent/s<br />

CERTIFICATION TO BAR ACTION<br />

This is to certify that the above-captioned case was dismissed pursuant<br />

to the Order dated ______________, for complainant/s<br />

_______________ (name) and ______________ (name) willful failure<br />

or refusal to appear for hearing before the Punong Barangay/Pangkat<br />

ng Tagapagkasundo and therefore complainant/s is/are barred from<br />

filing an action in court/government office.<br />

This ________ day of ______________, 19____.<br />

_____________________________<br />

Lupon Secretary/Pangkat Secretary<br />

Attested:<br />

________________________________<br />

Lupon Chairman/Pangkat Chairman<br />

IMPORTANT: If Lupon Secretary makes the certification, the Lupon<br />

Chairman attests. If the Pangkat Secretary makes the certification, the<br />

Pangkat Chairman attests.<br />

108 A HANDBOOK

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