FOR POLICE BLOTTER ENCODER USE ONLY

BLOTTER ENTRY NUMBER

2022-012 Philippine National Police
TYPE OF INCIDENT
Murder with homicide INCIDENT RECORD FORM
INSTRUCTIONS: Refer to PNP SOP on ‘Recording of Incidents in the Police Blotter’ in filling up this form. This Incident Record Form (IRF) may be reproduced, photocopied,
and/or downloaded from the DIDM website, www.didm.pnp.gov.ph.
DATE AND TIME REPORTED: DATE AND TIME OF INCIDENT:
JUNE 01, 2022 JUNE 01, 2022 ITEM “A” - REPORTING PERSON
FAMILY NAME FIRST NAME MIDDLE NAME QUALIFIER NICKNAME
ABAD GERICKSON PAUIG

CITIZENSHIP SEX/GENDER CIVIL STATUS DATE OF BIRTH (DD/MM/YY) AGE PLACE OF BIRTH HOME PHONE MOBILE PHONE
FILIPINO MALE SINGLE 11/25/2000 21 LUCBAN ROXAS, ISABELA 0968-519-7060

CURRENT ADDRESS (HOUSE NUMBER/STREET) VILLAGE/SITIO BARANGAY TOWN/CITY PROVINCE

YEBAN SUR BENITO SOLIVEN ISABELA

OTHER ADDRESS (HOUSE NUMBER/STREET) VILLAGE/SITIO BARANGAY TOWN/CITY PROVINCE

HIGHEST EDUCATIONAL ATTAINMENT OCCUPATION ID CARD PRESENTED EMAIL ADDRESS (If Any)
COLLEGE LEVEL abadgerickson@gmail.com

ITEM “B” - SUSPECT DATA

 CHECK HERE IF THERE IS NO SUSPECT INVOLVED AND THEREAFTER PROCEED TO ITEM “C”.
 CHECK HERE IF THERE ARE TWO OR MORE SUSPECTS. THEREAFTER, USE ADDITIONAL INCIDENT REPORT FORM SHEETS FOR EACH OF THE SUSPECTS.
FAMILY NAME FIRST NAME MIDDLE NAME QUALIFIER NICKNAME
ABAD KENDRICK UY

CITIZENSHIP SEX/GENDER CIVIL STATUS DATE OF BIRTH (DD/MM/YY) AGE PLACE OF BIRTH HOME PHONE MOBILE PHONE
FILIPINO MALE MARRIED 07/10/1994 35 CAUAYAN CITY 0998-427-4646

CURRENT ADDRESS (HOUSE NUMBER/STREET) VILLAGE/SITIO BARANGAY TOWN/CITY PROVINCE

BOLINAO AURORA ISABELA

OTHER ADDRESS (HOUSE NUMBER/STREET) VILLAGE/SITIO BARANGAY TOWN/CITY PROVINCE

HIGHEST EDUCATIONAL ATTAINMENT OCCUPATION WORK ADDRESS RELATION TO VICTIM EMAIL ADDRESS (If Any)
HIGH SCHOOL LEVEL DRIVER CAUAYAN CITY

IF AFP/PNP PERSONNEL: RANK UNIT ASSIGNMENT GROUP AFFILIATION WITH PREVIOUS CRIMINAL RECORD? [ ] Yes [ ] No STATUS OF PREVIOUS CASE
(If Yes, Pls. Specify)

HEIGHT WEIGHT COLOR OF EYES DESCRIPTION OF EYES COLOR OF HAIR DESCRIPTION OF HAIR UNDER THE INFLUENCE?
5’5” 75 Kgs BROWN BLACK  NO  DRUGS  LIQUOR
 OTHERS

FOR CHILDREN IN CONFLICT WITH THE LAW

NAME OF GUARDIAN GUARDIAN ADDRESS HOME PHONE MOBILE PHONE

DIVERSION MECHANISM

OTHER DISTINGUISHING FEATURES (DESCRIBE IN DETAIL CLOTHES, VEHICLE, SUNGLASSES, WEAPON/S, SCARS, AND OTHER DATA OR ACTIVITY OF THE SUSPECT/S WHICH WERE OBSERVED BY THE
REPORTING PERSON AND/OR WITNESS/ES TO IDENTIFY THE SUSPECT/S. THESE ARE IMPORTANT AND MAY BECOME EVIDENCE TO IDENTIFY, AND LINK TO THE CRIME, THE SUSPECT/S. USE
ADDITIONAL SHEET/S IF NECESSARY)

--------------------------------------CUT HERE. ISSUE THIS RECEIPT TO THE REPORTING PERSON-------------------------------------------

BLOTTER ENTRY NUMBER
2022-006 INCIDENT RECORD TRANSACTION RECEIPT
NAME OF REPORTING PERSON: ADDRESS OF REPORTING PERSON:
THIS CERTIFIES THAT JENNYFER C. CORBITO MACATAL AURORA, ISABELA
REPORTED AN INCIDENT TO BE TYPE OF INCIDENT:
RECORDED IN THE POLICE BLOTTER SHOOTING INCIDENT
WHICH INVOLVES AND
DATE/TIME OF REPORT: DATE/TIME OF INCIDENT: PLACE OF INCIDENT: RECORDED BY:
JUNE 16, 2022 JUNE 16, 2022 STA. ROSA AURORA, ISABELA
RANK/NAME/SIGNATURE OF DESK OFFICER
 ITEM “C” – VICTIM DATA
 CHECK HERE IF THE REPORTING PERSON (ITEM “A”) IS THE VICTIM. PROCEED TO ITEM “D”.
 CHECK HERE IF THERE ARE TWO OR MORE VICTIMS. USE ADDITIONAL INCIDENT REPORT FORM SHEETS FOR THE DATA OF THE ADDITIONAL VICTIMS.
FAMILY NAME FIRST NAME MIDDLE NAME QUALIFIER NICKNAME
PINEDA JAKE RUIZ

CITIZENSHIP SEX/GENDER CIVIL STATUS DATE OF BIRTH (DD/MM/YY) AGE PLACE OF BIRTH HOME PHONE MOBILE PHONE
FILIPINO MALE SINLE 02/24/1999 23 AURORA, ISABELA 0912-345-6475

CURRENT ADDRESS (HOUSE NUMBER/STREET) VILLAGE/SITIO BARANGAY TOWN/CITY PROVINCE

STA. ROSA AURORA ISABELA

OTHER ADDRESS (HOUSE NUMBER/STREET) VILLAGE/SITIO BARANGAY TOWN/CITY PROVINCE

HIGHEST EDUCATIONAL ATTAINMENT OCCUPATION WORK ADDRESS EMAIL ADDRESS (If Any)
COLLEGE LEVEL

ITEM “D” - NARRATIVE OF INCIDENT

BLOTTER ENTRY NUMBER TYPE OF INCIDENT TIME DATE PLACE OF INCIDENT
2022-006 SHOOTING INCIDENT 4:30 PM JUNE 16, 2022 STA. ROSA AURORA, ISABELA

ENTER IN DETAIL THE NARRATIVE OF THE INCIDENT OR EVENT, ANSWERING THE WHO, WHAT, WHEN, WHERE, WHY AND HOW OF REPORTING. (USE ADDITIONAL SHEET/S IF NECESSARY)

ON/ABOUT JUNE 16 2022 – 4:30PM, THERE IS A SHOOTING INCIDENT AT STA ROSA AURORA, ISABELA. THE VICTIM ONE JAKE RUIZ PINEDA, COLLEGE GRADUATE, MALE, SINGLE, BORN ON FEBRUARY 24,
1999, 23 YEARS OLD, RESIDENT ON STA. ROSA AURORA, ISABELA. THEY FIND THE VICTIM IS WASHING HIS MOTORCYCLE INFRONT OF THERE HOUSE AND THE SUSPECT SHOT THE VICTIM BY RIDING A
MOTORCYCLE WITHOUT PLATE NUMBER. UNDER MANHUNT OPERATION THE SUSPECT ARRESTED MR. FRANCIS A.K.A “BOYET” HIGH SCHOOL GRADUATE, DRIVER, FILIPNIPO, MARRIED, BORN ON JULY
10, 1994, 28 YEARS OLD, HEIGHT 5’5”, WEIGHT 75 kgs, RESIDENT ON BOLINAO AURORA, ISABELA AND RECOVERED 4 SLUNGS OF CALIBER 45 WITH UNKNOWN SN. THE VICTIM FOUND 4 GUN SHOT
WOUNDS, CHEST AND BROUGHT TO THE NEAREST HOSPITAL AND DECLARED “DEAD ON ARRIVAL”

(DETAILS OF THIS NARRATIVE SHALL BE THE BASIS IN THE ENTRY OF RECORD IN THE POLICE BLOTTER)

AUTHENTICATION
I HEREBY CERTIFY TO THE CORRECTNESS OF THE NAME/SIGNATURE OF REPORTING PERSON NAME/SIGNATURE OF DESK OFFICER
FOREGOING TO THE BEST OF MY KNOWLEDGE AND
BELIEF. JENNYFER CACHOLA CORBITO

CASE DISPOSITION (For Chief/Head of Office Use Only)

CHIEF Of STATION/OFFICE INSTRUCTIONS NAME OF DESIGNATED INVESTIGATOR-ON-CASE NAME OF CHIEF OF STATION/OFFICE
DAVID A. MILLER WILLIAM C. BROWN JOHNSON P. SMITH

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INSTRUCTIONS TO REPORTING PERSON
Keep this Incident Record Transaction Receipt (IRTR). An update of the progress of the investigation of the crime or incident that you reported
will be given to you upon presentation of this IRTR. For your reference, the data below is the contact details of this police station.
AURORA POLICE STATION
Name of Police Station Telephone
WILLIAM C. BROWN 0909-123-6543
Investigator-on-Case Mobile Phone
Name of Chief/Head of JOHNSON P. SMITH 0934-764-2573
Mobile Phone
Office