50843171 Certificate to File Action

Republic of the Philippines City of Manila Barangay ______  OFFICE OF THE BARANGAY CAPTAIN  _________________________,  _________________________, Complainant,

- versus -

Barangay Case No. _______________   For: _________________________ ___________________________  __ 

 __________________________  __________________________,, Respondent. x ------------------------------------------------------------------------------------ x

CERTIFICATE TO FILE ACTION

This is to certify that: Complainant ________________________ ________________________ (name) and respondent ________________________  ________________________  (name) failed to or refuse to:  _______ Obey summons summons or to appear for hearing  _______ No settlement/conciliation settlement/conciliation was was reached  _______ Settlement has been repudiated And therefore, the corresponding complaint between the parties may now be filed in court/government office concern. This ___ day of ___________, 200__.  ________________________  ________________________________  ________  Lupon/Pangkat Secretary

ATTESTED BY:  __________________________  ___________________________  _  Lupon/Pangkat Chaiman