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Republic of the Philippines
National Police Commission
PHILIPPINE NATIONAL POLICE
SANCHEZ MIRA POLICE STATION
Sanchez Mira, Cagayan

SMPSJune 01, 2014

CERTIFICATION

TO WHOM IT MAY CONCERN:

THIS IS TO CERTIFY that based on the Police Blotter of this station, as shown on Page No. 6, under Entry No. C-2014-014, dated June 01, 2014, the following entries of events exist, to wit:

Jun. 01, 2014/1500H/C-2014-14

SERIOUS PHYSICAL INJURY

Stated in this portion is the statement of facts that answer the 5W’s and 1H pertaining to this incident.

The reportee has affixed his signature this 1st day of June 2014.

Sgd. Daryl John I. Rante
(Reportee)

This certification is issued upon request of Mr. Rante for whatever legal purposes and intents is may serve.

Prepared By:

Joel G. Eclarin Jr.
PO3 PNP
Officer-on-case

NOTED BY:

REYNANTE DE GRACIA
Police Superintendent
Chief of Police

FM:COP SMPSCLR

TO:PD NEPPO ATTN PIIB -P-

CN:SRPES-IN-06-01-14011500 JUN 2014

PD SPOT RPT OM HIT AND RUN PD 00A 1400H 06-01-14 ALPHA CONSTITUTE A SERIOUS PHYSICAL INJURY TRANSPIRED AT C2 SM CAG CMA WHEREIN THE VICTIM CMA IDENTIFIED AS ONE DOMINIC PACIS WAS THAT HE BUMPED RESULTING TO THE OFFENSE BY THE SUSPECT CMA IDENTIFIED AS ONE JAY AR DADIS A FLORIDA DRIVER PD INVESTIGATION DISCLOSED THAT CRIME COMMTD WAS DONE THROUGH RECKLESS IMPRUDENCE RESULTING TO SERIOUS PHYSICAL PD THE SUSPECT HAS BEEN ARRESTED BY THE PENALTY OF ARRESTO MAYOR AND PROGRESS RPT TO FOLLOW PD OFFICER ON CASE DASH JOEL ECLARIN PD FOR INFO PD BT

DRAFTERRELEASER:

ECLARIN JGDE GRACIA RI
Officer-on-caseChief of Police

FM:COP SMPSCLR

TO:PD NEPPO ATTN PIIB -P-

CN:SRPES-IN-06-01-14011500 JUN 2014

PD PROG RPT REOURD MSG CN SMPS-IN-06-01-14 PD PLS BE INFORMED THAT OOA JUNE 01,...
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