No.
___________________
LIQUIDATION REPORT
Date: _________________
DEPARTMENT OF EDUCATION
ISABELA CITY SCHOOLS DIVISION Responsibility Center
PARTICULARS AMOUNT
To liquidate: The amount of (AMOUNT IN WORDS) (NET OF TAX 5%) (AMOUNT IN FIGURES)
Please find attached important documents for immediate referance.
To liquidate: CASH ADVANCE - School MOOE for the month of _(MONTH & YEAR)
Total Amount Spent
Amount of Cash Advance per DV No. (AMOUNT IN FIGURES)
Amount Refended per OR No.___Dated______
Amount to be reimbursed #VALUE!
A. Certified: correctness of B. Certified: Purpose of Travel/ C. Supporting Documents
the above data. Cash Advance duly accomplished Complete and proper
(NAME OF SCHOOL HEAD) JULIETO H. FERNANDEZ,Ed.D.,CESO VI ARIANE JOY F. ZERRUDO
Claimant Immediate Supervisor Head Accounting Unit