(To be fled up by the BIR) , > soo =: Sram apa ia Documentary Stamp Tax psa Oe Declaration/Return 2000 ere Background Information ST T a. ee Wp? See reaarenr Cote Cscunaon “Taxpayers Name (For indvidua) Last Name, Fret Name, Middle NarielFor Nonndviduas) Registered Namo fo = rr Details of Transactions For constructive affitare of documentary stamps) ‘Details of Documentary Stamps PurcnasediP. Tae of ansaceTParioaees | Tax base [—tanae I Tarde Fan 1 al T=] ari te waacton he party the oboe pany ze % ed arama 2 Tarr norigapooae ren Hef 2H Taper cton Rane Taxpayer onticaton Number [Section 8 (Fora motoring machine user)” iis Computation of Documentary Stamps Inventory Beforethis Purchases well as of Consumption Since Last Purchase Date Purchase Date _[ Tat Purchase Amount [Begining Balance [Lets Consumed | Bales Before ts Puchar TE lied ge LLL : luetering Machine Information Rachie Brand L Sorat Number I BIR Permit Number ‘Recount Naber far ey] TC : “iazap Tax Consumipiion Tor Replenishment or Loading in the Watering Machine To Schade Tat he back for he" Detals of Documentary amps ba accompa by coecon gets) TRcLUSIVE TRANSACTION DATES a ie Le 3 qawoON 15. Total Tax Due/Amount PurchasediAmount Remitted 16 Less: Tax Ped in Dalaation/ Return Provousy Fle. ths isan Amended Declaration Rtum [17 Tax Su Dust (Overpayment) a Is8 Ada: Penaitos ‘Surcharge Interest Compromise of of 1 i180 ss ” 9. Total Amount Payable! (Overpayment) (Sum of tems. 17 and 18D) : scat C101 Te amp of Rocehana Deny Tat Ts Gocaraton has been mage in 9o0d fair, vera by me, and to thebestof iy Tecate cer fe peraies cone sn betas run and cared prsant oe provsons of the Naonal neal Revenue Code 8 amended, andthe OffctAAB and roguatone esd under surly hereot Date of Recep 2 a (hos Sonate! Senor” een er ee Troe SY TRAST SRT TROT TR TT SS USE TRIS z sia ot Paymen Number oT ‘mount 2g z0| : 20 2391 ache Vaidaton Revenue Offaal Receipt Detais (i not led wih the bank)