Republic of the Philippines

DEPARTMENT OF TRANSPORTATION
LAND TRANSPORTATION OFFICE
AGUILA RD. CITY OF SAN FERNANDO, (LA UNION)

Field Office: SAN FERNANDO LA UNION,DISTRICT OFFICE TIN: 000865491002

Office Code: 0136 Date: 09/26/2023 6:30 PM

OFFICIAL RECEIPT 0136-000000127922

RECEIVED FROM (Last Name, First Name Middle Name)
DE LA CRUZ, ROSELYN GARCIA
ADDRESS (No. Street, Barangay, Municipality, Zip Code, Province)
Purok 2, Patpata, Balaoan, 2517, La Union
TIN (Tax Identification Number) LTO Client ID / LTO BUSINESS ID
23-921126-9476455

PAYMENT DETAILS BREAKDOWN OF PAYMENT

Transaction No: MAIRD-SAR-20230920- Cost of plate PHP 120.00
866420
MVUC PHP 720.00
Plate No: 599IFA Science Tax PHP 40.50
File No: 013623000366114
Classification: Private - (PVT) Transfer Fee PHP 50.00

Vehicle Type: MC W/O SIDECAR Legal Research Fee PHP 10.00

Fuel Type: Gasoline
Aircon Type: N/A
Color: WHITE/CYAN
Year Model: 2023
This payment is valid until
09/2026 and due for
renewal on 09/22/2026-
09/30/2026.

TOTAL AMOUNT PAID: PHP 940.50

AMOUNT IN WORDS: NINE HUNDRED FORTY PESOS AND 50/100
CENTAVO(S)

MODE OF PAYMENT: SM Bills

LOCATION: -

This is a system generated Official Receipt. No Signatures needed.

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