— Accountant Fors No, 51-C (ORIG! Revise January 1992 Official Receipt Of the Republic of the Philippines N° 0012668 A Date 7/4 Fund Agency: LAGUNA LakE DEVELOPMENT AUTHORITY s JTHORITY fice AssessmentNo. : [C076 Date : 1 Belfact Gaon. Payor PTT F Son PTT Belfast Slation Nature of Account smaune Collection Code Amou —= 7 TOTAL PHP | _ = Date TOTAL San Approved by A q ‘Amount in Words Five Thausani samen 7 aad Signatare Over Prin net = Nee ; wasn | Pe Number Date Amount GC Cheek 1 Money Orde SHOE ding Onticer ipt on NOTE: Write the number Und date of this re the back of check or money order received. Scanned with CamScanner