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Lis of Crime Incidents

Brgy. __________________________
Period Covered: ____________________
VICTIM'S DATA SUSPECT'S DATA STATUS OF CASE

CIVIL STATUS

CIVIL STATUS
Date and Time Date and Time
Blotter Entry # Reported Committed Offense Committed With Certificate
Settled For Conciliation

NAT

NAT
AGE

AGE
SEX

SEX
NAME NAME For Record
to File Action

Prepared by: Noted By:

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