Investigation Data Form 4i1f39

Republic of the Philippines Department of Justice National Prosecution Service OFFICE OF THE PROSECUTOR QUEZON CITY

INVESTAGATION DATA FORM To be accomplished by the Office DATE RECEIVED NPS DOCKET NO.: (stamped and initiated):_____________________ XV-03-INV-14____________-__________ Timed received:___________________________ Assigned to:__________________________ Receiving Staff:__________________________ Date Assigned:_______________________ To be accomplish by the complainants/ Counsel, Law Enforcer (Use back portion if space is not sufficient)

COMPLAINANT/S: Name, Sex, Age & Address LEONILA C. WATANABE, female, of legal age, Filipino citizen, and residing at No. 23 Pingkian 1, Central, Barangay Pasong Tamo, Tandang Sora, Quezon City

RESPONDENT/S: Name,Sex,Age, & Address JOEY L. TABBU, and RONILA TABBU both of legal ages, residing at 235 MacArthur Street, Area 1-A Pasong Tamo, Tandang Sora, Quezon City.

OFFENSE/S COMMITTED/ LAW/S VIOLATED: WITNESS/ES: Name & Adress Joey Tabbu: for RA 9262, for ESTAFA, for Marites C. Torres and Elizabeth T. Delosata who Malicious Mischief. are both residing at No. 23 Pingkian, Central, Barangay Pasong Tamo, Tandang Sora, Quezon Ronila Tabbu: for ESTAFA, for Malicious City Mischief . DATE & TIME OF COMMISSION: December 2013 to Present 1. 2. 3.

PLACE OF COMMISSION Quezon City

Has a similar complaint been filed before any other office?* Answer: NO Is this complaint is in the nature of a counter- affidavit?* Answer: NO If yes, indicated details below. Is this complaint related to another case before this office?* Answer: NO If yes, indicate details below.

I.S./NPS Docket No.:__________________________________ Handling Prosecutor:________________________________ CERTIFICATION I CERTIFY, under oath, all the information on this sheet are true and correct to the best of my knowledge and belief, that I have not commenced any action of filed any claim involving the same issues in any court, tribunal, or quasi-judicial agency, and that I should thereafter learn that qa similar action has been filed and/or is pending I shall report that fact to this Honorable Office within five (5) days from knowledge thereof.

___________________________________ (Signature Over Printed Name) SUBSCRIBED AND SWORN TO before me this_____day of _____________________, 20_____, in _____________________. _______________________________________ istering Prosecutor/ Officer *1,2,3 and CERTIFICATION need not be accomplished for inquest cases.