Republic of the Philippines

LGU-Pamplona, Cagayan
Pamplona, Cagayan

DISBURSEMENT VOUCHER
Mode of
Payment Cash Others

TIN/Employee No. Oblogation Request No.

EMILIANO C. ALILAM JR.
Payee
Responsibility Center
LGU PAMPLONA, CAGAYAN
Address Office/Unit/Project Code

EXPLANATION AMOUNT

P 2,128.20

P 2,128.20
A Certified B Certified

Allotment obligated for the purpose as indicated a Funds Available

Supporting documents complete

Signature: Signature:

Printed AILEEN GRACE A. Date Printed Date

AGCAOILI Name RUDY T. RAMOS
Name

Municipal Accountant Municipal Treasurer

Position: Position:
(Head Accounting Unit/Authorized Representative) ( Treasurer/Authorize Representative)
C Approved for Payment D Received Payment
Check No. Bank Name Date
Signature:

Printed Date
Name AARON P. SAMPAGA Signature:

Printed
Municipal Mayor Name EMILIANO C. ALILAM JR. Date
Position:
Agency Head/Authorized Representative Other Documents JEV No. Date
 Republic of the Philippines
Province Of Cagayan
LGU - PAMPLONA

OBLIGATION REQUEST No:

Payee SHIELAGIL C. CAILO
Office
Address LGU, PAMPLONA, CAGAYAN
Responsibility Account
Particulars
Center F. F. P. Code Amount
Travel Expenses P 1,310.00

Total - - P 1,310.00
A. Certified B. Certified

Charges to appropriation/allotment necessary, Existence of available appropriation

lawful and under my direct supervision.
Supporting documents valid, proper and legal

Signature: Signature:

Printed Name: Printed Name: PURIFICACION B. BORROMEO

Position: Municipal Mayor Position: Municipal Budget Officer
Head, Requesting Office Head, Budget Unit
Date: Date: