REPUBLIC OF THE ___________ )

PROVINCE OF _____ ) S.S

MUNICIPALITY OF ______ )

AFFIDAVIT

That I, ________ of legal age, _______, married and a resident of

___________, after had been duly sworn in accordance with law , hereby depose
and say:

1. That I am duly elected Punong Barangay of Barangay ___________

2. That I personally know that Lot No. ___ owned by the late _______
and was lately declared in the name of ______________ upon his death;

3. That I personally know the late ______, who was the care-taker of the
lot of ______, and spouses ______ , who took over the lot thereafter the death of
________;

4. That sometime in ____, the spouses _____ went to the Office of

Punong Barangay to report that a certain _____, daughter of _____, came to the
lot in _______ claiming possession of the said lot but the spouses refused to
surrender the possession thereof. However, since the lot was owned by the heirs of
______, as shown in the _________ presented by _____, I have advised the
spouses _____ to vacate the lot but they refused;

5. That on _____, ______ reported to the Office of Punong Barangay that

____________ together with some hired men entered Lot No. 515 and climbed
up the _____ therein and gathered the fruits but the Office of the Barangay
Captain cannot act on the complaint for the land was declared in the heirs of
_____ and not of the _____’;

6. That later on that same day, ______ went to the Office of the Punong
Barangay informing that ______ reported to the ______ that _____ and their
minor son _____ were climbing coconut trees in their lot and gathering some
fruits therein;
 7. That when we arrived at the area ____ saw me, the ____, ___ and her
hired laborers coming and he ran away together with her son _____;

8. That we have apprehended ____ together with the ___ fruits she has
gathered and piled and the policemen took pictures of it ;

9. That when the house of the ____ was searched about ___ meters
away from the area I have seen hundreds of coconuts were piled up and the
____officers took pictures of the same;

10. That I am executing this affidavit to attest to the truth of the

foregoing facts and for such other legal purpose.

IN WITNESS WHEREOF, I have hereunto affixed my signature this day

___of ____ at ________.

________________
Affiant

SUBSCRIBED AND SWORN to before me this ___ day of _____ at

______. This is to certify that I have personally examined the affiant and I am
satisfied that she personally executed and understood her affidavit.

_________________
Prosecutor