Liquidation Report: Date
Liquidation Report: Date
Liquidation Report: Date
PARTICULARS
Amount
TOTAL AMOUNT SPENT AMOUNT OF CASH ADVANCE PER DV NO. DTD. AMOUNT REFUNDED PER OR NO. ____________ DTD. ________________ AMOUNT TO BE REIMBURSED A Certified: Correctness of the above data B Certified: Purpose of travel/cash advance duly accomplished C Certified: Supporting documents complete and proper
___________________________ Claimant
REPORT OF DISBURSEMENTS Department of Environment and Natural Resources Visayas Avenue, Diliman, Quezon City Period Covered: DATE June 16, 2005 June 16, 2005 July 05, 2005 July 05, 2005 July 05, 2005 July 27, 2005 August 05, 2005 August 10, 2005 August 17, 2005 June 16 - August 17, 2005 PAYEE Complink Marketing Inc. SM Prime Holdings Inc. John & David Computer Center NBS - North EDSA SM Prime Holdings Inc. Copylandia Office Systems Corp. John & David Computer Center Stamp Attack Center ATM Macroprints Services & Ent. PARTICULARS Computer Printer Ink Parking fee Computer Printer Ink (hp 3550) Partchment Paper Parking fee Repair of Motor Computer Printer Ink (hp 3550) Rubberstamp Letterhead Printing TOTAL CERTIFICATION O.R. NO. 17513 50270776 2401 7469901674011026 0408099120 127586 2471 4651 0520 Report No.: ________________ Sheet No.: ________________ AMOUNT 07 11,640.00 10,655.00 202.50
I hereby certify that this Report of Disbursement in _________ sheets is a full, true, and correct statement of the disbursements made by me and that this is in liquidation of the cash advance granted last ___________ in the amount of P 49,102.70 per Check No. 312437AD dated June 2, 2005.
_____________ ____________
AMOUNT 09
30.00
30.00 3,186.99
3,246.99