BLOTTER ENTRY NUMBER

Philippine National Police

2023 - 11
TYPE OF INCIDENT INCIDENT RECORD FORM
MURDER

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:
November 13, 2023 at November 13, 2023 at
9:30 pm 6:25 pm
ITEM “A” - REPORTING PERSON
FAMILY NAME FIRST NAME MIDDLE NAME QUALIFIER NICKNAME

YUSAPI DIEGO TAN PILO

CITIZENSHIP SEX/GENDER CIVIL STATUS DATE OF BIRTH (DD/MM/YY) AGE PLACE OF BIRTH HOME PHONE MOBILE PHONE
Filipino Male Married January 8, 1997 26 ALLEN NORTHERN SAMAR 09101619910

CURRENT ADDRESS (HOUSE NUMBER STREET) VILLAGE/SITIO BARANGAY TOWN/CITY PROVINCE

PUROK 2, Brgy. /
Poblacion Norte POBLACION NORTE ALLEN NORTHERN SAMAR
OTHER ADDRESS (HOUSE NUMBER/STREET) VILLAGE/SITIO BARANGAY TOWN/CITY PROVINCE

HIGHEST EDUCATIONAL ATTAINMENT OCCUPATION ID CARD PRESENTED EMAIL ADDRESS (If Any)

COLLEGE LEVEL FARMER 19000 - 00645

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
MAGDARANSOY HILL NAGA BUGSOK

CITIZENSHIP SEX/GENDER CIVIL STATUS DATE OF BIRTH (DD/MM/YY) AGE PLACE OF BIRTH HOME PHONE MOBILE PHONE

FILIPINO MALE SINGLE SEPTEMBER 9, 1998 25 CATARMAN NORTHERN SMARA 0963544877

CURRENT ADDRESS (HOUSE NUMBER/STREET) VILLAGE/SITIO BARANGAY TOWN/CITY PROVINCE

PUROK 5, Brgy. Poblacion Norte POBLACION NORTE ALLEN NORTHERN SAMAR

OTHER ADDRESS (HOUSE NUMBER/STREET) VILLAGE/SITIO BARANGAY TOWN/CITY PROVINCE

HIGHEST EDUCATIONAL ATTAINMENT OCCUPATION WORK ADDRESS RELATION TO VICTIM EMAIL ADDRESS (If Any)
ELEMENTARY CONSTRUCTION WORKER BRGY. NORTH SAN JOSE N. FRIEND
SAMAR
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?
5’5 57KG BLACK ROUND EYES BLACK FADED  NO  DRUGS  LIQUOR
 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
INCIDENT RECORD TRANSACTION RECEIPT
NAME OF REPORTING PERSON: ADDRESS OF REPORTING PERSON:
THIS CERTIFIES THAT

REPORTED AN INCIDENT TO BE TYPE OF INCIDENT:

RECORDED IN THE POLICE BLOTTER
WHICH INVOLVES AND
DATE/TIME OF REPORT: DATE/TIME OF INCIDENT: PLACE OF INCIDENT: RECORDED BY:

RANK/NAME/SIGNATURE OF DESK OFFICER

Name of Police Station Telephone

Investigator-on-Case Mobile Phone

Name of Chief/Head of
Mobile Phone
Office

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

YUSAPI JULYO TAN RAMJO

CITIZENSHIP SEX/GENDER CIVIL STATUS DATE OF BIRTH (DD/MM/YY) AGE PLACE OF BIRTH HOME PHONE MOBILE PHONE
FILIPINO MALE MARRIED JUNE 22, 1998 25 ALLEN NORTHERN SAMAR 09237778989

CURRENT ADDRESS (HOUSE NUMBER/STREET) VILLAGE/SITIO BARANGAY TOWN/CITY PROVINCE

PUROK 2, BRGY. POBLCION NORTE POBLACION NORTE ALLEN NORTHERN SAMAR

SAN ISIDRO ALLEN N. SAMAR
OTHER ADDRESS (HOUSE NUMBER/STREET) VILLAGE/SITIO BARANGAY TOWN/CITY PROVINCE

HIGHEST EDUCATIONAL ATTAINMENT OCCUPATION WORK ADDRESS EMAIL ADDRESS (If Any)

COLLEGE LEVEL CONTRACTOR SAN JOSE N. SAMAR

ITEM “D” - NARRATIVE OF INCIDENT

BLOTTER ENTRY NUMBER TYPE OF INCIDENT TIME DATE PLACE OF INCIDENT
2023 - 11 MURDER 6:25 PM NOVEMBER BRGY. NORTH SAN JOSE N. SAMAR
13, 2023
 13 November 2023 a stabbing incident transpired in Brgy. North San
Jose Northern Samar at 6: 25 pm, the suspect identified as Magdaransoy Hill
alyas “bugsok” a constraction worker and the victim is identified Yusapi Julyo
Tan a contractor on the same job. Yusapi Diego brother of a victim telled that
at 6:25 pm he caught in the act that bugsok with a 7 inches balisong used in
crime, together with his brother who is lying on the ground with multiple
wounds. After the incident the suspect immediately fled away, but the victim
was declared dead on the spot. It was said that the motive of the crime is the
delayed 2 moths salary of his brother to the suspect .

(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 Yusapi Diego TAN Pssg. Marlon Calicoc
BELIEF.

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

PCPL. FRITZ MENTE Pssg. Jake Baliccud PCPL. FRITZ MENTE

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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.