CASH DISBURSEMENTS RECORD

Melrose Pacino
Accountable Officer
Date
1-Jan
2-Jan
3-Jan
4-Jan
5-Jan
6-Jan
7-Jan
8-Jan
9-Jan
10-Jan
11-Jan
12-Jan
13-Jan
14-Jan
15-Jan
16-Jan
17-Jan
18-Jan
19-Jan
20-Jan
21-Jan
22-Jan
23-Jan
24-Jan
31-Jan

Reference/
Payroll No./
DV No.

Check No. 54321

Invoice No. 0987
Invoice No. 0988
Invoice No. 0989
Invoice No. 1350
Invoice No. 1351
Invoice No. 1352
Invoice No. 1353
Invoice No. 4351
Invoice No. 4352
Invoice No. 4353
Invoice No. 4354
Invoice No. 67651
Invoice No. 67652
Invoice No. 67653
Invoice No. 3416
Invoice No. 3417
Invoice No. 3418
Invoice No. 3419
Check No. 54322
Invoice No. 1234
Invoice No. 1235
Invoice No. 1236
Invoice No. 1237
Invoice No. 1238

Official Designation
Name of Payee
Melrose Pacino
National bookstore
National bookstore
National bookstore
Mercury Drug
Mercury Drug
Mercury Drug
Mercury Drug
Shell
Shell
Shell
Shell
Expression
Expression
Expression
McDo
McDo
McDo
McDo
Melrose Pacino
Mercury Drug
Mercury Drug
Mercury Drug
Mercury Drug
Mercury Drug

Supplies

Medicines

2,500.00

3000
1500
2500
1500
2500
3000

1500
1500
1500
1500
1500
C E R TI F I CATI O N

I hereby certify that the foregoing is a correct and complete record of all cash advances
received and disbursements made by me in my capacity as _____________________________ of
___________________________________________ during the period from _______________ to
_______________, inclusives, as indicated in the corresponding columns.

For Accountable Officers' Use

AO 6/15/02

87

Appendix 37

CASH DISBURSEMENTS RECORD

DSWD- COA
Agency

SWO III
Official Designation
Gasoline

COA
Station
Foods

Miscellaneous

Cash Advance
Received

Disbursements

30,000
###

3000
1500
2500
1500
2500
3000
500
500
1500
500
100
500
200
150
1500
100
100

500
500
1500
500
100
500
200
150
1500
100
100
22,150

1500
1500
1500
1500
1500
C E R TI F I CATI O N

correct and complete record of all cash advances

my capacity as _____________________________ of
_______ during the period from _______________ to

_______________________________
Name and Signature
________________
Date

87

Cash Advance
Balance

30,000
27,500
24,500
23,000
20,500
19,000
16,500
13,500
13,000
12,500
11,000
10,500
10,400
9,900
9,700
9,550
8,050
7,950
7,850
30,000
28,500
27,000
25,500
24,000
22,500
22,500