Republic of the Philippines
DISBURSEMENT VOUCHER
DV No.
Date:
Barangay: 583_ Zone 57
City/Municipality: ____________________
Province: ___________________________
District IV
NAME AND ADDRESS OF BARANGAY TREASURER:
TIN No.
Fund:
________________
PARTICULARS
AMOUNT
To liquidate the cash advance received for personal services/laborers/nutrition project P
for the period _________Qtr/s CY 20___ in the amount of ..
Add: Redeposit/Refund .
__________________
TOTAL
Recap:
(
)
Page 1
2
(
)
(
)
TOTAL
P ___________________
Personal services
Honoraria
addl honoraria
lupon
Tanod allowances
St. sweeper
Others
laborers for the projects
nutrition project
_______________
_______________
_______________
_______________
_______________
_______________
_______________
_______________
_______________
_______________
_______________
_______________
_______________
_______________
_______________
_______________
List of supporting documents attached:
_____ payrolls _______ sheets
_____ deposit slips
_____ summary of receipts
_____ official receipts/Cash Invoice
_____ _______________________
_____ _______________________
A certified
Appropriation exist and funds available
for the charges/expenses indicated above
____________________________
Signature Over Printed Name
Chairman, Committee On Appropriation
Date ______________
B. Certified
Supporting documents complete
and proper, and funds available.
____________________________
Signature Over Printed Name
Barangay Treasurer
Date ______________
C. Approved
As to validity. Properly, legally and for comment
____________________________
Signature Over Printed Name
Punong Barangay
Date ______________
D.
I hereby certify that this Report Disbursement is a full, true and correct statement of the disbursement made by
me and that this is in liquidation of the cash granted last ____________________ in the amount of P __________
Per check No. _____________________ dated ____________________.
_______________________
Barangay Treasurer