DISBURSEMENT VOUCHER

Barangay: Tel. No. Payee/Office: Address: City/Municipality: Province: Employee No. ________________ TIN No.: PARTICULARS

B Certified:
Existence of available appropriations for the charges/expenses indicated above. Signature: Printed Name: Position: Date:

B Certified:

B Certified:

Signature: Printed Name: Position: Date:

Signature: Printed Name: Position: Date:

B Received Payment: Check No.: _________________ Bank Name: _________________ OR Number: _________________ Date:

Signature Over Printed Name/Date

Date:

DV No.: Date:

Fund: General Fund