BJ Form No.

20-A

REPUBLIC OF THE PHILIPPINES

CITY OF ILOILO
BARANGAY CALAHUNAN, ZONE 1, DISCTRICT OF MANDURRIAO

OFFICE OF THE LUPON TAGAPAMAYAPA

Gray Mountain
_______________________ Barangay Case No. ________
_______________________ Unlawful Detainer
For: ___________________
Complaint/s,

-against-

Blue Valentine,
______________________
Scarlet Snow, and
______________________
Red Sparrow

Respondent/s.

X-- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- x

CERTIFICATION TO FILE ACTION

This is to certify that:

1. There has been a personal confrontation between the parties before the Punong
Barangay but mediation failed;

2. The Pangkat ng Tagapagkasundo was constituted but the personal confrontation

before the Pangkat likewise did not result into a settlement.

Therefore, the corresponding complaint for the dispute may now be filed in
court/government office.

1st July
8
This____ day of _____________________, 201___.

__________________________
Violet Dimaculangan
Lupon Secretary

ATTESTED BY:

__________________________
Brown Fox
Pangkat Chairman