Annex “G ”

Republic of the Philippines

Judicial Region:
Court :
Station :

ACKNOWLEDGEMENT RECEIPT

Date: _______________________

Received from Executive /Presiding Judge:_______________________________________________of

(Name)
_______________________________________________________the amount of_________________
(Court Station)
___________________________________ (P______________) representing Maintenance and Other
(amount in words) (amount in figures)
Operating Expenses (MOOE) allotment for the period_________ ____to ________ ______, 20____
(month) (day) (month) ( day) (year)
(__________semester) of__________________________________________.
(1st semester/2nd semester) (Court Station)

Received by:

Name of Officer :___________________________

Official Designation :____________________________
Court Station :____________________________

Note: Pls. accomplish this form in five (5) copies:

1. Original/file copy- COA, SC

2. Certified copy –Accounting Division, FMO-OCA
3. Certified copy-Property Division, OAS-OCA
4. Certified copy – SDO (Executive/Presiding Judge)
5. File Copy –Court/Branch/OCC