DV No.

DISBURSEMENT VOUCHERS Date:

Barangay: City/Municipality:

Tel: Province:

Payee/Officer: Employee No: Fund

Address: Tin:

PARTICULARS AMOUNT

A) Certified B) Certified C) Certified

Existence of available appropriations for Funds (Cash) Available As to validity, propriety

charges/expenses indicated above. and legality of claims.

Approved for Payment,

Signature: Signature: Signature:

Printed Name: Printed Name: Printed Name:
Position: Chairman, Comm. On Appropriation Position: Barangay Treasurer Position: Punong
Date: Date: Barangay
Date:
D. Received Payment:

Check No. Date:

Signature Over Printed Name Bank Name:
Date: OR Number: Date: