bate: af 7 (203 DECLARATION OF GROSS RECEIPTS (Recount Narber [E=mal Adress [nai ohoimallcom OSCAR TOCSON PENASALES Feta dae tame ast ame Businese/Frade Name Pen Works Architecture ond interiors Business Address ‘Pagadian St, Puerto Real Subd. Tabuc Suba, Lapa, lilo Cy Landine Ho, 03008 ‘917-302-0180 [No of Employees [Males Tear 7] ‘Breakdown of Monthly Gross Sales or Receipts for CY 2021 (or RENEWAL) ine of usin ‘non-essential 36000006 rebrear 35,000.00] 120,000.00 il 7289464.29] [May 128,718.75 ne 195,000.00 uly 60,000.00] [august 500,000.00 [September 234,521.43 [october 320,000.00 [november 370,000.00 [oecember 720,000.00 TOTAL 77383,005.7 = lease check box of desired made of payment: Amu Cisne Bomey Oath of Undertaking eb cry he acre) ad eres of ny deans crane Neri and wndetaks to comp wth neces repulsoy reaurement fr te tn of sims prt an aon o ee bythe uo hy Ordanee wth 0 ay om the cate ache Ponped omy bse sfc tl omnexcemoeseton ‘Sees nf fae On repme) stone [VERIFICATION OF DOCUMENTS Required Doument Issuing Office / Agency: Date ksved Remar Barangay Clearance cay — = ire Safety inspection Coreate [Bureau of Fire Protection Verte by ‘Approval Recommended by