Republic of the Philippines

Province of Cagayan
Municipal of Gattaran
BARANGAY CUMAO

OFFICE OF LUPONG TAGAPAMAYAPA

Barangay Case: ______

For: _______________________
________________________
Cumao, Gattaran, Cagayan
-Complainant-

-Against-

________________________
Cumao, Gattaran, Cagayan
-Respondent-
SUMMONS

To:
Cumao Gattaran, Cagayan
-Respondents-

You are hereby summoned to appear before me in person, together with your
witnesses, on the day of 201__, at the Barangay Hall at in the
afternoon then and there to answer to a complaint made before me, copy of which is
attached hereto, for mediation/conciliation of your dispute with complainant.

You are here by warned that if you refuse of willfully fail to appear in obedience
to this summon, you may be barred from filling any counterclaim arising from said
complainant.

FAIL NOT or else face/punishment as to contempt to court.

This day of 201

LUPON CHAIRMAN

OFFICER’S RETURN

I served summon upon respondent , on the _____

day of__________________, 201___, [write names of respondent before made by
which was served].

Respondents:
________________ 1.Handling to him said summon in person.
________________ 2.Handling to him said summon and he refused to receive it.
________________ 3.Leaving said summon at his/her dwelling at_______________
A person of suitable age and discretion residing therein.
________________ 4.Leaving said summon at his/her office of business ____________
A competent person in charge thereof.

Received by: Respondents/ Representative.

_____________________________ _____________________________
Signature Officer Serving the summon

_____________________________
Signature