Republic of the Philippines

Department of Justice
National Prosecution Service
OFFICE OF THE CITY PROSECUTOR
City of Cebu

INVESTIGATION DATA FORM

To be accomplished by the Office:

DATE RECEIVED: NPS DOCKET NO. VII-09-INV-18 _______

Time Received: Assigned to Prosecutor:
Receiving Staff: Date Assigned :
Date Raffled:
__________________________________________________________________________
To be accomplished by complainant/counsel/law enforcer
(Use back portion if not sufficient)
COMPLAINANT/S: Name, Sex, Age, and Address: RESPONDENT/S: Name, Sex, Age and Address:
HAYDEE T. CANETE, Female, 42, Sta. ROMEO B. TAMPOS, Male, 60, Pondol
Cruz, Balamban, Cebu Balamban, Cebu
GEMMA C. TAMPOS, Female, 58,
Pondol Balamban, Cebu
LAW/S VIOLATED:
Violation of Article 172 (1) in relation to
WITNESSES: Name, Address
Article 171 (1) and (2) of the Revised HAYDEE T. CANETE with address
Penal Code on Falsification of Public previously stated
Document.
PLACE OF COMMISSION:
DATE & TIME of COMMISSION: Cebu City since the document were
27 July 2005 notarized in Cebu City.

1. Has a similar complaint been filed before any other Office? YES _ NO X
2. Is this complaint in the nature of counter-charge? YES _ NO X
3. Is this complaint related to another case before this Office? YES X NO _
If yes, indicate details below.
NPS Docket No.: . VII-09-INV-181-02292
Handling Prosecutor: ________________________

CERTIFICATION

I CERTIFY, under oath, that all information on this sheet are true and correct to the best
of my knowledge and belief, that I have not commenced any action or filed any claim involving
the same issues in any court, tribunal, or quasi-judicial agency, and that if I should thereafter learn
that a similar action has been filed and/or is pending, I shall report that fact to this Honorable
Office within five (5) days from knowledge thereof.

ATTY. GARRI SOLOMON R. FERNANDEZ

(Signature over printed name)

SUBSCRIBED AND SWORN TO before me this 9th day of November 2018, in Cebu City,
Philippines.

______________________________
Prosecutor Administering Oath