Appendix 44
LIQUIDATION REPORT Serial No.: _________________
Period Covered ________________ Date: _____________________
Entity Name : PSHS CARC Responsibility Center Code:
Fund Cluster : 01 RAF __________________________
PARTICULARS AMOUNT
Cash Advance Amount
Less; Actual Expenses
Difference 0
TOTAL AMOUNT SPENT 0
AMOUNT OF CASH ADVANCE PER DV NO.______DTD. ______ 0
AMOUNT REFUNDED PER OR NO. ________DTD. ___________ 0
AMOUNT TO BE REIMBURSED 0
A Certified: Correctness of the B Certified: Purpose of travel / C Certified: Supporting
above data cash advance duly accomplished documents complete and proper
Signature
Name of Employee Name of Division Supervisor LEMUEL P. BANTIC
Designation Accountant II
JEV No.: ___________________
Date: ______________________ Date: _____________________ Date: _____________________
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