Republic of the Philippines Province of Cagayan Municipality of Penablanca Barangay Alimannao OFFICE OF THE BARANGAY CAPTAIN

_____________________________ ______ Complainant/s ______________________ Against _____________________________ Respon!ent/s

Barangay Case No. For

CERTIFICATION TO FILE ACTION THIS IS TO CERTIFY THAT, " $ " Respon!ent/s ______________________________________ #illfully faile! to obey or to appear for hearing No settlement conciliation #as reache!. %ettlement has been repu!iate! an! therefore the correspon!ing complainant for the !ispute may no# be file! in court &overnment 'ffice.

&iven this _____ !ay of _______________________()*+ at Alimannao, Penablanca, Cagayan.

ROSEMARIE L. MONTEMAYOR Barangay %ecretary

A--.%-./ B0 RODERICK P. CARAG Barangay Captain