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Republic of the Philippines

MUNICIPALITY OF SAN MANUEL


Province of Pangasinan
(AGENCY)
DV No.:
DISBURSEMENT VOUCHER
Barangay: City/Municipality: SAN MANUEL Date:
Payee: Province: PANGASINAN Fund:
Address: TIN:
PARTICULARS AMOUNT

A. Certified as to existence of appropriation B. Certified As to availability of C. Certified as to validity,


for obligation funds for the purpose, and propriety, and legality of claim
completeness and propriety of and approved for payment
supporting documents

(Signature Over Printed Name) (Signature Over Printed Name) (Signature Over Printed Name)
Chairman, Committee on Appropriation Barangay Treasurer Punong Barangay

D. Received Payment:
Check No.:
Bank Name: Landbank of the Philippines Date:
Signature Over Printed Name OR No.:

E. Accounting Entries
Account Account Code Debit Credit

Prepared By:

Barangay Record Officer Date

Approved By:
______________________ ________________
City/Municipal Accountant Date

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