LIQUIDATION/ SETTLEMENT OF LOST

SCHOOL BOOKS/SUPPLIES/EQUIPMENT
SCHOOL: ______________________________ ___________________
DISTRICT:______________________________ (DATE)

_______________________________________
_______________________________________
CLASSIFICATION ADDRESS
QTY. DESCRIPTION OF BOOKS /SUPPLIE EQUIPMENT
DATE ACQURED NO. YRS. USED DEPRECIATION TOTAL REMARKS
COST AMOUNT PAID

I. I hereby certify to have total from __________________________________

___________________________ __________________ ( _______________ )
of books/supplies/tools/equipment, other as i herein above I turn/submitted
to______________________________________ this day of
_____________________

________________________________
(Name )

________________________________
( Designation )
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Receipt
R
2. I hereby certify have received the amount of
____________________________________
 ( P _____________________) Pesos as turn –over / submitted by Mr. / Mrs./
___________
________________________ of _____________________________________
as payment
For lost of books/ School property. This serves as his/her receipt of the
amount submitted.
COPY FURNISHED:
The School Division Superintendent
______________________________
The Resident Auditor (Principal/District Supervisor)
Division Supply Officer II
District Supervisor