DV No: 23 -02 - 015

DISBURSEMENT VOUCHER
Date:

Barangay: GOVERNMENT OF (name of Barangay) Municipality: (Municipal / City)

Tel No.: (0917-56789012) Province : (Name of Province)

Payee/ Office: (Bank Account name of Supplier) Employee No.________ Fund: (Source of Fund)

Address: (Address of Supplier) TIN No.

Particular Amount

to the payment of Office Supplies for the barangay treasurer's

office; as per supporting papers hereto attached at the total amount of …........ 10,000.00

5% taxwithheld……… 500.00
1% taxwithheld……… 100.00
total…… 600.00 less taxwitheld……… 600.00

net amount………….. 9,400.00

A. Certified: B Certified: C Certified:

Existence of available appropriations for Funds ( cash) available As to validity,propriety, and legally claim
charges/ expences indicated above. Approve:
Payment
Signature____________________ Signature_____________________ Signature_______________
Printed Name: JUAN DELA CRUZ Printed Name: PEDRO PENDUKO Printed Name: MARIA CLARA
Position:Chairman Committee of Appro. Position: Barangay Treasurer Position: Punong Barangay
Date:___________________ Date: Date:

D Receive Payment:
Check No. (123456789) ____________Date

(Supplier name & signature) Bank Name (Bank Name & Branch)
Signature Over Printed Name
O.R. Number ____________Date
Date: __________________
E Accounting Entries
Account Account Code Debit Credit
Office Supplies & Materials Expense 5-02-03-010 10,000.00
Due to BIR 2-02-01-010 600.00
Cash in Bank-LCCA 1-01-02-010 9,400.00

(name of Municipal BRK) ________________

Barangay Book Keeper Date
Approved by:

(name of municipal accountant) ________________

Municipal Accountant Date