DV No.

_________________

DISBURSEMENT VOUCHER

Date:
Barangay:

______________________________

Payee/Office:
Address:

Municipality of USA

HOLLYWOOD

Tel. No.

_________________

SK ALANGALANG
_____________________________

Province of LEYTE
Employee No. ______
Fund:
TIN No. : ___________ ____________________

Particulars

Amount

To Pre-Payment for the travelling expenses and registration

of SK Council to the participation of Provincial Youth Summit on April
5-7, 2013 at Alangalang, Leyte;
as per supporting papers hereto attached , in the amount of . . . . . . . . . . . .

Total
A.
Certified:
Existence of available appropriations for the
charges/expenses indicated above

B.
Certified:
Fund (Cash) Available

17, 500.00

17, 500.00

C.
Certified:
As to validity, propriety, and legality of claim

Approved:
For Payment

Signature: ____________________________Signature: ____________________________

Signature: ____________________________
Printed Name: JUSTIN BEIBER
Printed Name: DANIEL PADILLA
Printed Name: JESSICA SANCHEZ
Position:Chairman Committee on Appropriation
Position:
Barangay Treasurer
Position:
Barangay Chairman
Date:
____________________________Date:
____________________________

D.

Check No. ______________________

Date: ____________
Bank Name: ______________________________________

SK ALANGALANG
Signature Over Printed Name
Date: ____________________

Date: ____________
OR Number: ____________________