Fund Cluster :

MATICMATIC ELEMENTARY SCHOOL

Entity Name 1101101

DISBURSEMENT VOUCHER
Date : 03-13-2023
DV No. 2023-03-0016

Mode of MDS Check √ Commercial Check ADA Others (Please specify)

Payment
_________________
TIN/Employee No.: ORS/BURS No.:
Payee MARIGOLD STORE
157-686-860-00000

Address A.B. Fernandez Ave., Dagupan City

Particulars Responsibility Center MFO/PAP Amount

PAYMENT FOR SEMI-EXPENDABLE EQUIPMENTS

& OFFICE SUPPLIES 20,885.00
700108010004 310400100002000
EWT 1% 186.47
WBT 5% 932.37

Amount Due 19,766.16

A. Certified: Expenses/Cash Advance necessary, lawful and incurred under my direct supervision.

PERLITA S. LLARENAS
Principal II

B. Accounting Entry:
Account Title UACS Code Debit Credit
Semi-Expendable Equipments 5020321000
14,750.00
Office Supplies Expenses 5020301000
6,135
Due to BIR 2010101000
1,118.84
Advances for Operating Expenses 1010202024

C. Certified: D. Approved for Payment 19,766.16

√ Cash available
√ Subject to Authority to Debit Account (when applicable)
Nineteen thousand seven hundred sixty-six pesos and 16/100
√ Sup
proper

Signature Signature

Printed
RONDEC EMIL H. PARAYNO Printed Name PERLITA S. LLARENAS
Name

Administrative Officer II Principal II

Position Position
Authorized Representative Agency Head/Authorized Representative

Date 3/13/2023 Date 3/13/2023

E. Receipt of Payment JEV No.
Check/ Bank Name & Account Number:
ADA No. : 03/13/2023
459839 LBP-CALASIAO-002642-1043-41
Date : Printed Name: Date
Signature :

Official Receipt No. & Date/Other Documents

Document Code: SDO1P-FR-109 Revision No.: 00 Page No.: Page 1 of 1Effectivity Date: 10-28-2019
 Appendix 60

PURCHASE REQUEST

Entity Name: LONGOS ELEMENTARY SCHOOL Fund Cluster: 01101101

Office/Section :
ACCOUNTING PR No.: 2023-08-0020 Date: 08-22-2023
Responsibility Center Code : 7001080010004
Stock/ Property
Unit Item Description Quantity Unit Cost Total Cost
No.
GAD 1st Day - Early Dinner 22 320.00 7040.00
GAD 2nd Day - Early Dinner 22 320.00 7040.00
GAD 3rd Day AM Snacks 22 75.00 1650.00
GAD 3rd Day Lunch 22 300.00 6600.00
GAD 3rd Day PM Snacks 22 75.00 1650.00

Purpose: For school use

OK as to APP

1
Requested by: Approved by:
Signature : ___________________________ ____________________________________
Printed Name : LOIDA F. CASTRO SHIRLY D. MIRANDA
Designation : Property Custodian Principal I
 Appendix 61
PURCHASE ORDER
LONGOS ELEMENTARY SCHOOL
Entity Name

Supplier : ELBONITAS CANTEEN P.O. No. : 2023-09-0059

Address : NAGSAING, CALASIAO, PANGASINAN Date : 09-12-2023
TIN : 708-361-314-00001 Mode of Procurement : SHOPPING
Gentlemen:
Please furnish this Office the following articles subject to the terms and conditions contained herein:

Place of Delivery : ___________________________________ Delivery Term : ________________________

Date of Delivery : ____________________________________ Payment Term : ________________________

Stock/ Property No. Unit Description Quantity Unit Cost Amount

Packs GAD 1st Day - Early Dinner 22 320.00 7,040.00
Packs GAD 2nd Day - Early Dinner 22 320.00 7,040.00
Packs GAD 3rd Day AM Snacks 22 75.00 1,650.00
Packs GAD 3rd Day Lunch 22 300.00 6,600.00
Packs GAD 3rd Day PM Snacks 22 75.00 1,650.00

(Total Amount in Words) Twenty three thousand nine hundred eighty 23,980.00

In case of failure to make the full delivery within the time specified above, a penalty of one-tenth (1/10) of one percent for
every day of delay shall be imposed on the undelivered item/s.

Conforme: Very truly yours,

__________________________ SHIRLY D. MIRANDA

Signature over Printed Name of Supplier Principal I

___________________________
Date

Fund Cluster : 01101101 ORS/BURS No. : ___________________

Funds Available : _________________________________ Date of the ORS/BURS: ____________

PRESCILA A. MEJIA, CPA Amount : _________________________

Accountant III
Signature over Printed Name