Region VI-Regional Trial Court JEP-23-000331020

MAMBUSAO, Capiz

Date and Time Paid: Aug 23, 2023 11:37 AM Transaction No.: ZKKfLCik3205
Date and Time Posted: Aug 23, 2023 11:37 AM Confirmation No.: 7215804642860
Mode of Payment: Online Payment - UPay Assessment No.: RTC742109360
Name of Payor: NENET G ESPOSO Reference No.: 9f731901f81b43f3b0ebc794e4cebedc
Nature of Collection: File Case, Supplemental Payment Status: PAID
Pleadings, and Answers
Case Type: Voluntary Recognition of Minor and Correction of Birth Certificate
Case No./Roll/MCLE/Bar N/A
Examinee No.
Case Title/Particulars: PETITION FOR CANCELLATION OF CERTIFICATE OF LIVE BIRTH OF MA. RHEA PALACIOS
GANZON. NENET GANZON ESPOSO, vs. MA. RHEA PALACIOS GANZON ET. AL.

Assessment details:

Type of Fund/Nature of Payment Filing Fee Miscellaneous Fee Total Amount

JDF 169.68 112.00 281.68
SAJF 335.32 288.00 623.32
LRF 10.00
VCF 5.00
MF 500.00
STF 1,000.00
TOTAL AMOUNT: ₱ 2,420.00

Payment details:

OR No. Date and Time Amount Paid Running Balance

JEP-23-000331020 Aug 23, 2023 11:37 AM ₱ 2,420.00 ₱ 0.00
LATEST AMOUNT PAID IN WORDS: TWO THOUSAND FOUR HUNDRED TWENTY AND 00/100**

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NOTE 1: This serves as the Legal Fees Form. Convenience fee or bank charges are not part of the collection of the court.

Payment Confirmed & Verified by:

MARICAR F. FABELLA
Clerk of Court VI

SCP-JEP Version 4.0 Page 1 of 1 Printed on 08/23/2023 - 11:41 AM