REPUBLIC OF THE PHILIPPINES

REGIONAL TRIAL COURT

THIRD JUDICIAL REGION
BRANCH 68
CAMILING, TARLAC

LEGAL FEES FORM

______CASE NO.__________

RECEIVED this _____day of _________________20______, the

following payments:

1. Special Allowance for the Judiciary (SAJ) PhP______OR No.__________

2. Judiciary Development Fund (JDF) PhP______OR No.__________

3. Fiduciary Fund (FF) PhP_______OR

No._______

4. Sheriff's Trust Fund (STF) PhP______OR

No.__________

5. Legal Research Fee (LRF) PhP______OR

No.__________

6. Land Registration Fee PhP_____OR

No.__________

7. Victim's Compensation Fee PhP______OR

No.__________

8. Mediation Fee (MF) PhP______OR

No.__________
 TOTAL
PhP__________

Paid by: ___________________________

Received by: ___________________________

Note: ___________________________