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REPORT OF ACCOUNTABILITY FOR ACCOUNTABLE FORMS

DENR - PENRO
Agency

Month of December ,2019

Accountable Forms Beginning Balance Receipt / Purchase Issuance Ending Balance


QTY Inclusive Serial Nos. QTY Inclusive Serial Nos. QTY Inclusive Serial Nos. QTY Inclusive Serial Nos.
Name of Form
Used From To From To From To From To
A. WITHOUT FACE VALUE
LBP Checks MDS
2078-9000-37 (101) 165 1119936 1120100 56 1119936 1119991 109 1119992 1120100

TRUST FUND
0782-1029-74 (101) 91 1338610 1338700 - - - - - - 91 1338610 1338700

0782-1130-20 (101) 94 0876407 0876500 - - - - - - 94 0876407 0876500


0782-1130-11 (101) 99 0876302 0876400 - - - - - - 99 0876302 0876400

CERTIFICATION
I hereby certify that the foregoing is a true statement of all accountable issued and transferred by me during the period above-stated
forms received, during the period above-stated and that the beginning and ending balances are correct.

FLORINA L. CAYABAN
Name & Signature of Accountable

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