DISBURSEMENT VOUCHER

SK of Barangay: DALUMPINAS DV No.:

City/Municipality: SAN NICOLAS Date:
Province: PANGASINAN
Payee: CLOVEN DG. MINA
Address: DALUMPINAS, SAN NICOLAS PANGASINAN
TIN:
Particulars Amount

REIMBURSEMENT OF 1 LITER OF CASTROL ACTIVE ESSENTIAL OIL AND TUNE-UP

LABOR AS PER SUPPORTING PAPERS ATTACHED HERETO.. 39-0.00

A. Certified as to availability B. Certified as to availability C. Certified as to necessity,

of the budget or funds received for of cash, and completeness and validity, propriety, and
specific purpose propriety of supporting legality of claim; and
documents Approved for payment:

RODEL L. MARTINEZ CLOVEN DG. MINA

(Signature Over Printed Name) JESSIELLE L. JAVIER (Signature Over Printed
Budget Monitoring Officer (Signature Over Printed Name) Name)
SK Treasurer SK
Date : Date : Date :
D. Received Payment: Check No.:
Date:
CLOVEN DG. MINA Bank
Name:
Signature Over Printed Name of Payee/ Bank
Authorized Representative Branch:
OR No.:
Date Date: