FOR POLICE BLOTTER ENCODER USE ONLY
BLOTTER ENTRY NUMBER
Philippine National Police
2023-023
TYPE OF INCIDENT
CLUBBING
INCIDENT RECORD FORM
INSTRUCTIONS: Refer to PNP SOP on ‘Recording of Incidents in the Police Blotter’ in filling up this form. This Incident Record Form (IRF) may be reproduced, photocopied,
and/or downloaded from the DIDM website, www.didm.pnp.gov.ph.
DATE AND TIME REPORTED: DATE AND TIME OF INCIDENT:
JAN. 20, 2023 - 10:00 PM JAN. 20, 2023 - 9:40 PM ITEM “A” - REPORTING PERSON
FAMILY NAME FIRST NAME MIDDLE NAME QUALIFIER NICKNAME
PEDRALVEZ TRIXIE RETONDO
CITIZENSHIP SEX/GENDER CIVIL STATUS DATE OF BIRTH (DD/MM/YY) AGE PLACE OF BIRTH HOME PHONE MOBILE PHONE
FILIPINO FEMALE MARRIED 09-10-1996 27 LAOAG CITY 09121256423
CURRENT ADDRESS (HOUSE NUMBER/STREET) VILLAGE/SITIO BARANGAY TOWN/CITY PROVINCE
#41, ALMAZAN STREET BRGY. 28 SAN BERNABE LAOAG CITY ILOCOS NORTE
OTHER ADDRESS (HOUSE NUMBER/STREET) VILLAGE/SITIO BARANGAY TOWN/CITY PROVINCE
HIGHEST EDUCATIONAL ATTAINMENT OCCUPATION ID CARD PRESENTED EMAIL ADDRESS (If Any)
COLLEGE GRADUATE HOUSEWIFE DRIVER'S LICENSE ptrixier@gmail.com
ITEM “B” - SUSPECT DATA
CHECK HERE IF THERE IS NO SUSPECT INVOLVED AND THEREAFTER PROCEED TO ITEM “C”.
CHECK HERE IF THERE ARE TWO OR MORE SUSPECTS. THEREAFTER, USE ADDITIONAL INCIDENT REPORT FORM SHEETS FOR EACH OF THE SUSPECTS.
FAMILY NAME FIRST NAME MIDDLE NAME QUALIFIER NICKNAME
PASCUAL NORWELL MARTIN
CITIZENSHIP SEX/GENDER CIVIL STATUS DATE OF BIRTH (DD/MM/YY) AGE PLACE OF BIRTH HOME PHONE MOBILE PHONE
FILIPINO MALE SINGLE 09-13-2001 21 LAOAG CITY 09295066230
CURRENT ADDRESS (HOUSE NUMBER/STREET) VILLAGE/SITIO BARANGAY TOWN/CITY PROVINCE
#36, ALMAZAN STREET BRGY. 28 SAN BERNABE LAOAG CITY ILOCOS NORTE
OTHER ADDRESS (HOUSE NUMBER/STREET) VILLAGE/SITIO BARANGAY TOWN/CITY PROVINCE
HIGHEST EDUCATIONAL ATTAINMENT OCCUPATION WORK ADDRESS RELATION TO VICTIM EMAIL ADDRESS (If Any)
norwellpascual@gmail.com
COLLEGE LEVEL LEGITIMATE SON
IF AFP/PNP PERSONNEL: RANK UNIT ASSIGNMENT GROUP AFFILIATION WITH PREVIOUS CRIMINAL RECORD? [ ] Yes [ ] No STATUS OF PREVIOUS CASE
(If Yes, Pls. Specify)
HEIGHT WEIGHT COLOR OF EYES DESCRIPTION OF EYES COLOR OF HAIR DESCRIPTION OF HAIR UNDER THE INFLUENCE?
STRAIGHT NO DRUGS / LIQUOR
180 cms 95 kg BROWN BLACK OTHERS ________________________
FOR CHILDREN IN CONFLICT WITH THE LAW
NAME OF GUARDIAN GUARDIAN ADDRESS HOME PHONE MOBILE PHONE
DIVERSION MECHANISM
OTHER DISTINGUISHING FEATURES (DESCRIBE IN DETAIL CLOTHES, VEHICLE, SUNGLASSES, WEAPON/S, SCARS, AND OTHER DATA OR ACTIVITY OF THE SUSPECT/S WHICH WERE OBSERVED BY THE
REPORTING PERSON AND/OR WITNESS/ES TO IDENTIFY THE SUSPECT/S. THESE ARE IMPORTANT AND MAY BECOME EVIDENCE TO IDENTIFY, AND LINK TO THE CRIME, THE SUSPECT/S. USE
ADDITIONAL SHEET/S IF NECESSARY)
--------------------------------------CUT HERE. ISSUE THIS RECEIPT TO THE REPORTING PERSON-------------------------------------------
BLOTTER ENTRY NUMBER
2023-023 INCIDENT RECORD TRANSACTION RECEIPT
NAME OF REPORTING PERSON: ADDRESS OF REPORTING PERSON:
THIS CERTIFIES THAT TRIXIE PEDRALVEZ BRGY 28 SAN BERNABE, ALMAZAN STREET, LAOAG CITY
REPORTED AN INCIDENT TO BE TYPE OF INCIDENT:
RECORDED IN THE POLICE BLOTTER CLUBBING INCIDENT
WHICH INVOLVES AND
DATE/TIME OF REPORT: DATE/TIME OF INCIDENT: PLACE OF INCIDENT: RECORDED BY:
PMSg JOHN PATRICK BARROGA
JAN. 20, 2023 - 10 PM JAN. 20, 2023 - 9:40 PM BRGY. 28, LAOAG CITY
RANK/NAME/SIGNATURE OF DESK OFFICER
ITEM “C” – VICTIM DATA
CHECK HERE IF THE REPORTING PERSON (ITEM “A”) IS THE VICTIM. PROCEED TO ITEM “D”.
CHECK HERE IF THERE ARE TWO OR MORE VICTIMS. USE ADDITIONAL INCIDENT REPORT FORM SHEETS FOR THE DATA OF THE ADDITIONAL VICTIMS.
FAMILY NAME FIRST NAME MIDDLE NAME QUALIFIER NICKNAME
PASCUAL LEOIGI MATEO
CITIZENSHIP SEX/GENDER CIVIL STATUS DATE OF BIRTH (DD/MM/YY) AGE PLACE OF BIRTH HOME PHONE MOBILE PHONE
FILIPINO MALE MARRIED 28-02-1978 45 LAOAG CITY 09192953956
CURRENT ADDRESS (HOUSE NUMBER/STREET) VILLAGE/SITIO BARANGAY TOWN/CITY PROVINCE
#36, ALMAZAN STREET BRGY. 28 SAN BERNABE LAOAG CITY ILOCOS NORTE
OTHER ADDRESS (HOUSE NUMBER/STREET) VILLAGE/SITIO BARANGAY TOWN/CITY PROVINCE
HIGHEST EDUCATIONAL ATTAINMENT OCCUPATION WORK ADDRESS EMAIL ADDRESS (If Any)
COLLEGE UNDERGRADUATE TRICYCLE DRIVER
ITEM “D” - NARRATIVE OF INCIDENT
BLOTTER ENTRY NUMBER TYPE OF INCIDENT TIME DATE PLACE OF INCIDENT
2023-030 CLUBBING 11:00 PM JAN. 20, 2023 BRGY. 28 SAN BERNABE, LAOAG CITY
ENTER IN DETAIL THE NARRATIVE OF THE INCIDENT OR EVENT, ANSWERING THE WHO, WHAT, WHEN, WHERE, WHY AND HOW OF REPORTING. (USE ADDITIONAL SHEET/S IF NECESSARY)
Initial investigation conducted disclosed that on January 20,2023 at about 9:40 PM,
clubbing incident transpired in Barangay 28, San Bernabe, Almazan Street, Laoag City,
Ilocos Norte. The victim Leoigi Pascual y Mateo, 45 years old, married, tricycle driver and
the suspect Norwell Pascual y Martin, 21 years old, student, son of the victim and both
resident of above stated place were having a drinking session in front of their dwelling,
they had a heated altercation where in the latter picked up a piece of steel pipe from their
garage and subsequently struck the victim. The victim loss of consciousness while the
suspect left the place and subject himself to Laoag City Police Station for voluntary
surrender and the former was brought to Karmelli Clinic and hospital for medical treatment
and later transferred to Mariano Marcos Hospital for further medical treatment. The motive
of the incident was due to heated arguments. Case was already referred to the office of the
Provincial Prosecutor docketed under NPS Number I-12-INQ-23J.
(DETAILS OF THIS NARRATIVE SHALL BE THE BASIS IN THE ENTRY OF RECORD IN THE POLICE BLOTTER)
AUTHENTICATION
I HEREBY CERTIFY TO THE CORRECTNESS OF THE NAME/SIGNATURE OF REPORTING PERSON NAME/SIGNATURE OF DESK OFFICER
FOREGOING TO THE BEST OF MY KNOWLEDGE AND
BELIEF. TRIXIE R. PEDRALVEZ PMSg JOHN PATRICK BARROGA
CASE DISPOSITION (For Chief/Head of Office Use Only)
CHIEF Of STATION/OFFICE INSTRUCTIONS NAME OF DESIGNATED INVESTIGATOR-ON-CASE NAME OF CHIEF OF STATION/OFFICE
PMAJ ABRAHAM LINCOLN TANGOL PEMS JOSEF T. ANGELES PMAJ ABRAHAM LINCOLN TANGOL
-----------------------------CUT HERE--------------------------------------------------------------------------------------CUT HERE------------------------------------------------------
INSTRUCTIONS TO REPORTING PERSON
Keep this Incident Record Transaction Receipt (IRTR). An update of the progress of the investigation of the crime or incident that you reported
will be given to you upon presentation of this IRTR. For your reference, the data below is the contact details of this police station.
Name of Police Station LAOAG CITY POLICE STATION Telephone 772-0201
Investigator-on-Case PEMS JOSEF T. ANGELES Mobile Phone 09458622153
Name of Chief/Head of
PCpt CYRIL R. SEBASTIAN Mobile Phone 09459933017
Office
